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OPTUM PHARMACY 702, LLC
CHC31892-00 Centerplace Health, Inc.
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Covered Entity Details
Entity Name
Centerplace Health, Inc.
Subdivision Name
Sally and Sam Shapiro Babies and Children&s Medical Center
Type
HRSA-Funded Health Center
340B ID
CHC31892-00
Entity Address
1750 17th St. BLDG E
Sarasota, FL 34234-8632
Grant Number
H80CS31892
Participating Start Date
10/1/2018
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
Anna Ferguson, Interim CEO
(941) 529-0200
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
1/10/2025
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