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OPTUM PHARMACY 702, LLC
STD85382 Institute for Liver Health
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Covered Entity Details
Entity Name
Institute for Liver Health
Subdivision Name
Peoria
Type
Sexually Transmitted Diseases
340B ID
STD85382
Entity Address
15396 N 83rd Avenue
Bldg E
Peoria, AZ 85381
Grant Number
nu51ps005142
Participating Start Date
1/1/2022
Last Recertification Date
5/5/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
1/20/2022
Contract Begin Date
1/25/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Anita Kohli, CEO
(434) 825-0921
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
1/20/2022
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