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OPTUM PHARMACY 705, LLC
STD85140 Institute for Liver Health
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Covered Entity Details
Entity Name
Institute for Liver Health
Subdivision Name
Flagstaff
Type
Sexually Transmitted Diseases
340B ID
STD85140
Entity Address
1150 North San Francisco St.
Flagstaff, AZ 86001
Grant Number
nu51ps005142
Participating Start Date
1/1/2022
Last Recertification Date
5/5/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 705, LLC
Pharmacy Address
1100 LEE BRANCH LN
BIRMINGHAM, AL 35242-7298
Pharmacy Comments
Contract Details
Approval Date
4/17/2023
Contract Begin Date
5/2/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Anita Kohli, CEO
(434) 825-0921
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/17/2023
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