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OPTUM PHARMACY 702, LLC
CH040650 PARK DUVALLE COMMUNITY HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
PARK DUVALLE COMMUNITY HEALTH CENTER, INC.
Subdivision Name
Park DuValle Community Health Center, Inc.
Type
HRSA-Funded Health Center
340B ID
CH040650
Entity Address
3015 Wilson Ave
Louisville, KY 40211-1969
Grant Number
H80CS00083
Participating Start Date
12/1/1992
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
10/10/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Swannie Jett, CEO
(502) 774-4401
Contract Pharmacy Representative
Optum
Nancy McCutcheon, Sr. VP of Strategic Sales
(651) 983-0677
Signed By Date
10/10/2023
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