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OPTUM PHARMACY 702, LLC
CHC31240-01 FIRST PERSON CARE CLINIC
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Covered Entity Details
Entity Name
FIRST PERSON CARE CLINIC
Subdivision Name
FIRST PERSON CARE CLINIC
Type
HRSA-Funded Health Center
340B ID
CHC31240-01
Entity Address
916 W Owens Ave
Las Vegas, NV 89106-2516
Grant Number
H80CS31240
Participating Start Date
4/1/2024
Last Recertification Date
2/26/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
7/11/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Diego Martinez, CEO
(305) 992-5149
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
7/11/2024
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