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OPTUM PHARMACY 702, LLC
STD334843 Universal Comprehensive Healthcare Services LLC
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Covered Entity Details
Entity Name
Universal Comprehensive Healthcare Services LLC
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD334843
Entity Address
7753 Lake Worth Road
Lake Worth, FL 33467
Grant Number
nu62ps924633
Participating Start Date
11/25/2024
Last Recertification Date
5/7/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
1/14/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Dr. Janice Victor, CEO
(973) 698-7768
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
1/14/2025
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