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OPTUM PHARMACY 702, LLC
STD32905 Healthcare Unity Group Inc
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Covered Entity Details
Entity Name
Healthcare Unity Group Inc
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD32905
Entity Address
1920 S. Babcock Street
Melbourne, FL 32901
Grant Number
H25PS005131
Participating Start Date
9/23/2022
Last Recertification Date
5/5/2025
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
Anthony John Walko III, Chief Executive Officer
(201) 783-3126
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
1/10/2025
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