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OPTUM PHARMACY 702, LLC
CH070300 NORTHEAST MISSOURI HEALTH COUNCIL, INC.
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Covered Entity Details
Entity Name
NORTHEAST MISSOURI HEALTH COUNCIL, INC.
Subdivision Name
Northeast Missouri Health Council, Inc.
Type
HRSA-Funded Health Center
340B ID
CH070300
Entity Address
1416 Crown Drive
Kirksville, MO 63501
Grant Number
H80CS00731
Participating Start Date
7/1/2004
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
10/9/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ANDREW GRIMM, EXECUTIVE DIRECTOR
(660) 627-5757
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/9/2023
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