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OPTUM PHARMACY 702, LLC
STD85224 Institute for Liver Health
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Covered Entity Details
Entity Name
Institute for Liver Health
Subdivision Name
Chandler
Type
Sexually Transmitted Diseases
340B ID
STD85224
Entity Address
2201 West Fairview St
Ste. 9
Chandler, AZ 85224
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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