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OPTUM PHARMACY 702, LLC
STD42304 Central Outreach Wellness Center
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Covered Entity Details
Entity Name
Central Outreach Wellness Center
Subdivision Name
Central Outreach Wellness Center Columbus
Type
Sexually Transmitted Diseases
340B ID
STD42304
Entity Address
2680 W Broad Street
Columbus, OH 43204
Grant Number
NH25PS005134
Participating Start Date
7/1/2022
Last Recertification Date
5/7/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
7/14/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Stacy Lane, Owner
(412) 608-8313
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
7/14/2022
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