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OPTUM PHARMACY 702, LLC
CH09287AA CHIRICAHUA COMMUNITY HEALTH CENTERS INC
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Covered Entity Details
Entity Name
CHIRICAHUA COMMUNITY HEALTH CENTERS INC
Subdivision Name
CCHCI Mobile Clinic
Type
HRSA-Funded Health Center
340B ID
CH09287AA
Entity Address
Chiricahua Community Health Centers, Inc Cochise County PO Box 263 Elfrida, AZ 85610
Elfrida, AZ 85610
Grant Number
H80CS00696
Participating Start Date
10/1/2023
Last Recertification Date
2/13/2024
Entity Termination Date
1/1/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
10/16/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Jonathan Melk, CEO
(520) 227-9167
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/16/2023
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