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OPTUM PHARMACY 702, LLC
CH074010 KONZA PRAIRIE COMMUNITY HEALTH CENTER INC
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Covered Entity Details
Entity Name
KONZA PRAIRIE COMMUNITY HEALTH CENTER INC
Subdivision Name
KONZA PRAIRIE COMMUNITY HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH074010
Entity Address
361 Grant Ave
Junction City, KS 66441-4201
Grant Number
H80CS00210
Participating Start Date
1/1/1997
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
10/14/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lee Wolf, Chief Executive Officer
(785) 238-4711 Ext: 1000
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/14/2022
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