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OPTUM PHARMACY 806, INC.
RWI93534 AIDS HEALTHCARE FOUNDATION
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Covered Entity Details
Entity Name
AIDS HEALTHCARE FOUNDATION
Subdivision Name
AHF Healthcare Center - Antelope Valley
Type
Ryan White Part A
340B ID
RWI93534
Entity Address
1669 W Avenue J
Suite 301
Lancaster, CA 93534
Grant Number
H89HA00016
Participating Start Date
4/1/2020
Last Recertification Date
2/20/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 806, INC.
Pharmacy Address
2288 AUBURN BLVD
STE. 102
SACRAMENTO, CA 95821-1618
Pharmacy Comments
Contract Details
Approval Date
7/9/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2025
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
7/9/2020
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