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OPTUM PHARMACY 702, LLC
RWII78759A Texas Health Action
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Covered Entity Details
Entity Name
Texas Health Action
Subdivision Name
Type
Ryan White Part B
340B ID
RWII78759A
Entity Address
2800 S. IH-35
Austin, TX 78704
Grant Number
X07 - HA00054
Participating Start Date
10/1/2019
Last Recertification Date
3/4/2025
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
Chris Adams, CFO
(512) 643-8770
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/15/2022
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