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OPTUM PHARMACY 702, LLC
STD44118 Central Outreach Wellness Center
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Covered Entity Details
Entity Name
Central Outreach Wellness Center
Subdivision Name
Central Outreach Wellness Center Cleveland Heights
Type
Sexually Transmitted Diseases
340B ID
STD44118
Entity Address
2040 Lee Road
Cleveland Heights, OH 44118
Grant Number
NH25PS005134
Participating Start Date
10/1/2021
Last Recertification Date
5/7/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
10/29/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Stacy Lane, Owner
(412) 608-8313
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/29/2021
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