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OPTUM PHARMACY 702, LLC
CHC26575-08 COMMUNITY HEALTH & WELLNESS PA
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Covered Entity Details
Entity Name
COMMUNITY HEALTH & WELLNESS PA
Subdivision Name
Community Health & Wellness Partners - Mobile Health Unit 1
Type
HRSA-Funded Health Center
340B ID
CHC26575-08
Entity Address
4879 US Highway 68 S
West Liberty, OH 43357-9525
Grant Number
H80CS26575
Participating Start Date
1/1/2025
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
4/15/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tara Bair, President/CEO
(937) 599-1411 Ext: 250
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
4/15/2025
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