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OPTUM PHARMACY 702, LLC
CH09025F CLINICAS DE SALUD DEL PUEBLO INC
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Covered Entity Details
Entity Name
CLINICAS DE SALUD DEL PUEBLO INC
Subdivision Name
Innercare Mecca
Type
HRSA-Funded Health Center
340B ID
CH09025F
Entity Address
91275 66TH AVE
STE 500
MECCA, CA 92254
Grant Number
H80CS00733
Participating Start Date
7/1/2004
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
10/13/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
YVONNE BELL, CEO
(760) 344-9951 Ext: 10102
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/13/2023
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