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OPTUM PHARMACY 704, INC.
RWI33308 AIDS Healthcare Foundation
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Covered Entity Details
Entity Name
AIDS Healthcare Foundation
Subdivision Name
AHF Healthcare Center - North Point
Type
Ryan White Part A
340B ID
RWI33308
Entity Address
6333 N. Federal Highway
Suite 302
Fort Lauderdale, FL 33308
Grant Number
H89HA00002
Participating Start Date
1/1/2013
Last Recertification Date
2/20/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 704, INC.
Pharmacy Address
5627 UNIVERSITY HTS STE 108
SAN ANTONIO, TX 78249
Pharmacy Comments
Contract Details
Approval Date
1/14/2021
Contract Begin Date
4/1/2021
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
1/14/2021
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