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OPTUM PHARMACY 702, LLC
CH046800 PERSON FAMILY MEDICAL CENTER
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Covered Entity Details
Entity Name
PERSON FAMILY MEDICAL CENTER
Subdivision Name
PERSON FAMILY MEDICAL CENTER, INC.
Type
HRSA-Funded Health Center
340B ID
CH046800
Entity Address
702 N Main St
Roxboro, NC 27573-4755
Grant Number
H80CS00483
Participating Start Date
4/1/2003
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
10/17/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
JANET Anne WALKER, CFO
(336) 599-2900 Ext: 355
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/17/2022
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