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OPTUM PHARMACY 702, LLC
FQHCLA462A HASC DIAGNOSTIC AND TREATMENT CENTER, INC.
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Covered Entity Details
Entity Name
HASC DIAGNOSTIC AND TREATMENT CENTER, INC.
Subdivision Name
HASC Diagnostic and Treatment Center
Type
Health Center Program Look-Alike
340B ID
FQHCLA462A
Entity Address
1122 Chestnut Ave
Brooklyn, NY 11230-5844
Grant Number
LALCS52978
Participating Start Date
4/1/2024
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
3/7/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tzvi Kahn, CEO
(718) 942-3860
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
3/7/2024
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