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OPTUM PHARMACY 702, LLC
CH092440 CLINIC INC, THE
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Covered Entity Details
Entity Name
CLINIC INC, THE
Subdivision Name
T.H.E. CLINIC, INC.
Type
HRSA-Funded Health Center
340B ID
CH092440
Entity Address
3834 S. WESTERN AVE
LOS ANGELES, CA 90062-1104
Grant Number
H80CS00755
Participating Start Date
7/1/2003
Last Recertification Date
2/20/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
1/11/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Clifford Shiepe, President and CEO
(323) 730-1920 Ext: 3053
Contract Pharmacy Representative
Optum
Kevin Hockley, optum
(612) 474-6761
Signed By Date
1/11/2024
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