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OPTUM PHARMACY 701, LLC
CH053110 INDIANA HEALTH CENTERS INCORPORATED
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Covered Entity Details
Entity Name
INDIANA HEALTH CENTERS INCORPORATED
Subdivision Name
INDIANA HEALTH CENTERS, INC.
Type
HRSA-Funded Health Center
340B ID
CH053110
Entity Address
8003 Castleway Dr
Indianapolis, IN 46250-1946
Grant Number
H80CS00668
Participating Start Date
12/1/1992
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 701, LLC
Pharmacy Address
1830 S HORNE
MESA, AZ 85204
Pharmacy Comments
Contract Details
Approval Date
10/15/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Nicole Meyer, COO
(317) 576-1335 Ext: 4137
Contract Pharmacy Representative
Avella
Nancy McCutcheon, Sr VP of Strategic Sales
(651) 983-0677
Signed By Date
10/15/2024
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