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OPTUM PHARMACY 702, LLC
STD029071 Rhode Island Public Health Institute
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Covered Entity Details
Entity Name
Rhode Island Public Health Institute
Subdivision Name
DBA Open Door Health
Type
Sexually Transmitted Diseases
340B ID
STD029071
Entity Address
7-9 Central Street
Providence, RI 02907
Grant Number
NH25PS005160
Participating Start Date
1/1/2020
Last Recertification Date
5/5/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
7/3/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lynne Malone, Chief Financial & Administrative Officer
(401) 952-1682
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
7/3/2023
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