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OPTUM PHARMACY 702, LLC
CHC11353-00 SPRINGFIELD MEDICAL CARE SYSTEMS INC
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Covered Entity Details
Entity Name
SPRINGFIELD MEDICAL CARE SYSTEMS INC
Subdivision Name
Ludlow Health Center
Type
HRSA-Funded Health Center
340B ID
CHC11353-00
Entity Address
1 Elm St.
Ludlow, VT 05149-1301
Grant Number
H80CS12873
Participating Start Date
1/1/2010
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
10/7/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Joshua Dufresne, CEO
(802) 886-8961
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
10/7/2024
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