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OPTUM PHARMACY 702, LLC
CHC28365-12 CIRCLE THE CITY
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Covered Entity Details
Entity Name
CIRCLE THE CITY
Subdivision Name
Circle the City Family Health Center, Downtown Campus
Type
HRSA-Funded Health Center
340B ID
CHC28365-12
Entity Address
220 S 12th Ave
Phoenix, AZ 85007-3101
Grant Number
H80CS28365
Participating Start Date
4/1/2023
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
1/16/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/13/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kim Despres, Chief Executive Officer
(602) 776-9000 Ext: 1003
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
1/16/2023
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