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OPTUM PHARMACY 702, LLC
RWI761111B AIDS Healthcare Foundation
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Covered Entity Details
Entity Name
AIDS Healthcare Foundation
Subdivision Name
AHF Healthcare Center - Houston Fannin
Type
Ryan White Part A
340B ID
RWI761111B
Entity Address
7400 Fannin Street
Suite 1118
Houston, TX 77054
Grant Number
H89HA00004
Participating Start Date
7/1/2018
Last Recertification Date
2/20/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
4/15/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
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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