Contract Pharmacy Details

OPTUM INFUSION SERVICES 500 INC
FQHCLA362 Clover Fork Outpatient Medical Project, Inc.

Covered Entity Details

Entity Name

Clover Fork Outpatient Medical Project, Inc.

Subdivision Name

Clover Fork Evarts

Type

Health Center Program Look-Alike

340B ID

FQHCLA362

Entity Address

101 Chad St
Evarts, KY 40828-8200

Grant Number

LALCS31536

Participating Start Date

4/1/2018

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

OPTUM INFUSION SERVICES 500 INC

Pharmacy Address

1893 GENERAL GEORGE PATTON DR
# 100
FRANKLIN, TN 37067-2655

Pharmacy Comments

Contract Details

Approval Date

7/12/2024

Contract Begin Date

10/1/2024

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/1/2024
Pharmacy closed

Contacts

Covered Entity Signing Official

Jack Miniard, Chief Executive Officer
(606) 837-2108 Ext: 122

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

7/12/2024

340B Drug Pricing Program Database