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OPTUM FRONTIER THERAPIES II, LLC
RWII761111 AIDS HEALTHCARE FOUNDATION
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Covered Entity Details
Entity Name
AIDS HEALTHCARE FOUNDATION
Subdivision Name
AHF HEALTHCARE CENTER FORT WORTH
Type
Ryan White Part B
340B ID
RWII761111
Entity Address
400 N. BEACH STREET SUITE 104
FORT WORTH, TX 76111
Grant Number
X07HA00054
Participating Start Date
1/1/2016
Last Recertification Date
2/26/2024
Entity Termination Date
4/1/2025
Pharmacy Details
Pharmacy Name
OPTUM FRONTIER THERAPIES II, LLC
Pharmacy Address
6425 SANTA MARGARITA ST UNIT 110
LAS VEGAS, NV 89118-1913
Pharmacy Comments
Contract Details
Approval Date
4/15/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Philip Ho, Senior Director of Pharmacy and 340B Compliance
(323) 860-5323
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/15/2020
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