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OPTUM PHARMACY 702, LLC
CHC33651-00 TULIP TREE HEALTH SERVICES OF GIBSON COUNTY, INC.
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Covered Entity Details
Entity Name
TULIP TREE HEALTH SERVICES OF GIBSON COUNTY, INC.
Subdivision Name
Tulip Tree Health Services of Gibson County, Inc. d/b/a Tulip Tree Family Health Care
Type
HRSA-Funded Health Center
340B ID
CHC33651-00
Entity Address
123 N Mccreary St
Fort Branch, IN 47648-1313
Grant Number
H80CS33651
Participating Start Date
10/1/2022
Last Recertification Date
2/27/2023
Entity Termination Date
4/1/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
10/13/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Kristine Georges, Executive Director
(812) 753-1039
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/13/2022
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