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OPTUM PHARMACY 702, LLC
STD337052 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 1C
Type
Sexually Transmitted Diseases
340B ID
STD337052
Entity Address
560 Jackson St North
Ste. 100
Saint Petersburg, FL 33705
Grant Number
H25PS005131
Participating Start Date
1/1/2023
Last Recertification Date
5/9/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
7/17/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
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
7/17/2023
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