Contract Pharmacy Details

OPTUM PHARMACY 702, LLC
STD33301 AIDS HEALTHCARE FOUNDATION

Covered Entity Details

Entity Name

AIDS HEALTHCARE FOUNDATION

Subdivision Name

Broward Wellness Center

Type

Sexually Transmitted Diseases

340B ID

STD33301

Entity Address

750 SE 3rd Ave.
1st Floor
FORT LAUDERDALE, FL 33316

Grant Number

NH25PS005131

Participating Start Date

7/1/2013

Last Recertification Date

5/30/2024

Pharmacy Details

Pharmacy Name

OPTUM PHARMACY 702, LLC

Pharmacy Address

1050 PATROL RD
JEFFERSONVILLE, IN 47130

Pharmacy Comments

Contract Details

Approval Date

7/9/2020

Contract Begin Date

10/1/2020

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

7/9/2020

340B Drug Pricing Program Database