Contract Pharmacy Details

OPTUM PHARMACY 702, LLC
CH09287K Chiricahua Community Health Centers, Inc.

Covered Entity Details

Entity Name

Chiricahua Community Health Centers, Inc.

Subdivision Name

CCHCI SEABHS Clinic

Type

HRSA-Funded Health Center

340B ID

CH09287K

Entity Address

4755 Campus Drive
Sierra Vista, AZ 85635

Grant Number

H80CS00696

Participating Start Date

1/1/2018

Last Recertification Date

2/13/2024

Entity Termination Date

7/1/2024

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

7/1/2024
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

340B Drug Pricing Program Database