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OPTUM PHARMACY 702, LLC
CHC28357-00 NORTH OLYMPIC HEALTHCARE NETWORK PC
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Covered Entity Details
Entity Name
NORTH OLYMPIC HEALTHCARE NETWORK PC
Subdivision Name
North Olympic Healthcare Network PC
Type
HRSA-Funded Health Center
340B ID
CHC28357-00
Entity Address
240 W FRONT ST
PORT ANGELES, WA 98362-2609
Grant Number
H80CS28357
Participating Start Date
1/1/2016
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
10/3/2022
Contract Begin Date
10/18/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/31/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Beau Jacob Brown, Chief Financial Officer
(360) 452-7891 Ext: 2828
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/3/2022
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