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OPTUM PHARMACY 702, LLC
STD18017 Novus Adult Care Services
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Covered Entity Details
Entity Name
Novus Adult Care Services
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD18017
Entity Address
1565 Linden Street
Bethlehem, PA 18017
Grant Number
NH25PS005144
Participating Start Date
4/1/2016
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
7/11/2022
Contract Begin Date
7/13/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Allen C Smith, Owner
(610) 867-5365
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
7/11/2022
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