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OPTUM PHARMACY 702, LLC
STD073051 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
STD073051
Entity Address
405 Kearny Ave
Kearny, NJ 07032
Grant Number
NU62PS924524-05-05
Participating Start Date
6/1/2023
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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