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OPTUM PHARMACY 702, LLC
STD27403 Triad Health Project
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Covered Entity Details
Entity Name
Triad Health Project
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD27403
Entity Address
801 Summit Avenue
Greensboro, NC 27405
Grant Number
6 NH25PS005152-02-01
Participating Start Date
4/1/2021
Last Recertification Date
5/9/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
4/15/2021
Contract Begin Date
4/19/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mark Cassity, Executive Director
(336) 275-1654
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/15/2021
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