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OPTUM PHARMACY 702, LLC
STD336094 West Central Gastroenterology dba Gastro Florida
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Covered Entity Details
Entity Name
West Central Gastroenterology dba Gastro Florida
Subdivision Name
Gastro Florida Division 18
Type
Sexually Transmitted Diseases
340B ID
STD336094
Entity Address
110 South MacDill Ave
Ste. 300
Tampa, FL 33609
Grant Number
H25PS005131
Participating Start Date
7/5/2022
Last Recertification Date
5/31/2023
Entity Termination Date
10/1/2023
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
1/13/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Seena Salyani, CEO
(727) 347-0536
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
1/13/2023
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