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OPTUM PHARMACY 702, LLC
CH091940 MENDOCINO COMMUNITY HEALTH CLINIC, INC.
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Covered Entity Details
Entity Name
MENDOCINO COMMUNITY HEALTH CLINIC, INC.
Subdivision Name
Hillside Health Center
Type
HRSA-Funded Health Center
340B ID
CH091940
Entity Address
333 Laws Ave
Ukiah, CA 95482-6540
Grant Number
H80CS00628
Participating Start Date
7/1/1995
Last Recertification Date
2/25/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
4/27/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Rod Grainger, CEO
(707) 472-4667
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/27/2023
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