Contract Pharmacy Details

OPTUM PHARMACY 702, LLC
CH037030 Mary's Center For Maternal And Child Care, Inc.

Covered Entity Details

Entity Name

Mary's Center For Maternal And Child Care, Inc.

Subdivision Name

Adams Morgan DC

Type

HRSA-Funded Health Center

340B ID

CH037030

Entity Address

2333 Ontario Rd NW
Washington, DC 20009-2627

Grant Number

H80CS04202

Participating Start Date

7/1/2014

Last Recertification Date

2/27/2025

Pharmacy Details

Pharmacy Name

OPTUM PHARMACY 702, LLC

Pharmacy Address

1050 PATROL RD
JEFFERSONVILLE, IN 47130

Pharmacy Comments

Contract Details

Approval Date

7/15/2024

Contract Begin Date

10/1/2024

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Rebecca Beyer, EVP of Compliance
(571) 289-8265

Contract Pharmacy Representative

Optum
Avani Patel, VP, 340B Operations
(763) 330-5555

Signed By Date

7/15/2024

340B Drug Pricing Program Database