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OPTUM PHARMACY 702, LLC
FQHCLA404 CHATTANOOGA C.A.R.E.S. DBA CEMPA COMMUNITY CARE
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Covered Entity Details
Entity Name
CHATTANOOGA C.A.R.E.S. DBA CEMPA COMMUNITY CARE
Subdivision Name
Cempa Community Care Clinic
Type
Health Center Program Look-Alike
340B ID
FQHCLA404
Entity Address
1000 E. 3rd Street Ste 300
Chattanooga, TN 37403-2153
Grant Number
LALCS33899
Participating Start Date
3/17/2020
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
4/18/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Shannon Stephenson, CEO
(423) 648-9911
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/18/2021
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