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OPTUM PHARMACY 705, LLC
STD336111 Midway Specialty Care Center
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Covered Entity Details
Entity Name
Midway Specialty Care Center
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD336111
Entity Address
3317 W Gandy Blvd
TAMPA, FL 33611
Grant Number
NH25PS005131
Participating Start Date
4/1/2018
Last Recertification Date
5/9/2023
Entity Termination Date
4/1/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 705, LLC
Pharmacy Address
1100 LEE BRANCH LN
BIRMINGHAM, AL 35242-7298
Pharmacy Comments
Contract Details
Approval Date
7/17/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Kathryn E Hayden, CFO
(772) 742-9276
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
7/17/2023
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