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OPTUM PHARMACY 702, LLC
CH063450 PRESBYTERIAN MEDICAL SERVICES, INC.
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Covered Entity Details
Entity Name
PRESBYTERIAN MEDICAL SERVICES, INC.
Subdivision Name
PRESBYTERIAN MEDICAL SERVICES
Type
HRSA-Funded Health Center
340B ID
CH063450
Entity Address
1422 PASEO DE PERALTA
SANTA FE, NM 87501-4391
Grant Number
H80CS00205
Participating Start Date
12/1/1992
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
7/13/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Stephen M. Quesada, DIRECTOR OF PHARMACY
(505) 443-2634
Contract Pharmacy Representative
Avella
Nancy McCutcheon, Sr VP of Strategic Sales
(651) 983-0677
Signed By Date
7/13/2022
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