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OPTUM PHARMACY 702, LLC
STD19405 Novus Adult Care Services
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Covered Entity Details
Entity Name
Novus Adult Care Services
Subdivision Name
Bridgeport
Type
Sexually Transmitted Diseases
340B ID
STD19405
Entity Address
512 DeKalb Street
Bridgeport, PA 19405
Grant Number
NH25PS005144
Participating Start Date
7/1/2021
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
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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