Contract Pharmacy Details

OPTUM PHARMACY 806, INC.
RWI917301 AIDS HEALTHCARE FOUNDATION

Covered Entity Details

Entity Name

AIDS HEALTHCARE FOUNDATION

Subdivision Name

AHF HEALTHCARE CENTER - UPLAND

Type

Ryan White Part A

340B ID

RWI917301

Entity Address

8263 GROVE AVE
SUITE 201
RANCHO CUCAMONGA, CA 91730

Grant Number

H89HA00032

Participating Start Date

7/1/2005

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

7/1/2024
Pharmacy closed

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