Contract Pharmacy Details

OPTUM FRONTIER THERAPIES II, LLC
RWI761111C AIDS Healthcare Foundation

Covered Entity Details

Entity Name

AIDS Healthcare Foundation

Subdivision Name

AHF Healthcare Center - Houston Binz

Type

Ryan White Part A

340B ID

RWI761111C

Entity Address

1200 Binz Street
Suite 1040
Houston, TX 77004

Grant Number

H89HA00004

Participating Start Date

7/1/2018

Last Recertification Date

2/20/2025

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

7/1/2020
Agreement registered in error

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

340B Drug Pricing Program Database