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OPTUM PHARMACY 702, LLC
CH051770 INDIAN HEALTH BOARD OF MINNEAPOLIS INC
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Covered Entity Details
Entity Name
INDIAN HEALTH BOARD OF MINNEAPOLIS INC
Subdivision Name
INDIAN HEALTH BOARD OF MINNEAPOLIS, INC.
Type
HRSA-Funded Health Center
340B ID
CH051770
Entity Address
1315 E 24th St
Minneapolis, MN 55404-3975
Grant Number
H80CS00441
Participating Start Date
7/1/2001
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
10/10/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Patrick Rock, CEO/Medical Director
(612) 721-9856
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
10/10/2024
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