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OPTUM INFUSION SERVICES 202, INC.
FQHCLA443 SPACE COAST HEALTH CENTERS INC
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Covered Entity Details
Entity Name
SPACE COAST HEALTH CENTERS INC
Subdivision Name
Space Coast Health Centers Primary Care - Titusville
Type
Health Center Program Look-Alike
340B ID
FQHCLA443
Entity Address
951 North Washington Ave
Suite 100
Titusville, FL 32796-2141
Grant Number
LALCS45787
Participating Start Date
4/1/2023
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
OPTUM INFUSION SERVICES 202, INC.
Pharmacy Address
9655 FLORIDA MINING BLVD W
STE 411
JACKSONVILLE, FL 32257-2041
Pharmacy Comments
Contract Details
Approval Date
4/10/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Arvin H Lewis, CEO
(321) 346-8031
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/10/2024
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