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OPTUM PHARMACY 700, LLC
RWII39216 AIDS Healthcare Foundation
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Covered Entity Details
Entity Name
AIDS Healthcare Foundation
Subdivision Name
AHF Healthcare Center - Jackson
Type
Ryan White Part B
340B ID
RWII39216
Entity Address
766 Lakeland Drive
Suite A
Jackson, MS 39216
Grant Number
X07HA00036
Participating Start Date
10/1/2017
Last Recertification Date
2/20/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 700, LLC
Pharmacy Address
5700 DOT COM CT, STE 1000
OVIEDO, FL 32765
Pharmacy Comments
Contract Details
Approval Date
1/14/2021
Contract Begin Date
2/10/2021
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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