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OPTUM PHARMACY 702, LLC
CHC26516-00 Free Clinic Of The New River Valley Inc
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Covered Entity Details
Entity Name
Free Clinic Of The New River Valley Inc
Subdivision Name
Montgomery Clinic
Type
HRSA-Funded Health Center
340B ID
CHC26516-00
Entity Address
215 Roanoke St
Christiansburg, VA 24073-3025
Grant Number
H80CS26516
Participating Start Date
10/1/2019
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
1/10/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Albert Brogan, CFO
(540) 525-0623
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
1/10/2025
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