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OPTUM PHARMACY 702, LLC
STD336173 Midway Specialty Care Center Inc
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Covered Entity Details
Entity Name
Midway Specialty Care Center Inc
Subdivision Name
Sexually Transmitted Diseases
Type
Sexually Transmitted Diseases
340B ID
STD336173
Entity Address
11454 N 53rd Street
Temple Terrace, FL 33617
Grant Number
NH25PS005131
Participating Start Date
4/1/2022
Last Recertification Date
5/14/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
2/15/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kathryn E Hayden, CFO
(772) 742-9276
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
1/18/2022
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