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OPTUM PHARMACY 702, LLC
CH0213350 ZUFALL HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
ZUFALL HEALTH CENTER, INC.
Subdivision Name
DOVER COMMUNITY CLINIC
Type
HRSA-Funded Health Center
340B ID
CH0213350
Entity Address
18 West Blackwell Street
Dover, NJ 07801-4506
Grant Number
H80CS04211
Participating Start Date
7/1/2005
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
1/14/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Frances Palm, President & CEO
(973) 328-9100 Ext: 1333
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
1/14/2025
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