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OPTUM PHARMACY 702, LLC
STD33312 HIGHT IMPACTO INC
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Covered Entity Details
Entity Name
HIGHT IMPACTO INC
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD33312
Entity Address
2221 SW 36 avenue
Fort Lauderdale, FL 33312
Grant Number
NH25PS004342
Participating Start Date
4/1/2021
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
4/15/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
JORGE GARDELA, CEO
(954) 295-9721
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/15/2022
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