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OPTUM PHARMACY 702, LLC
STD708081 AIDS Healthcare Foundation
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Covered Entity Details
Entity Name
AIDS Healthcare Foundation
Subdivision Name
AHF Healthcare Center - Baton Rouge (Goodwood)
Type
Sexually Transmitted Diseases
340B ID
STD708081
Entity Address
8281 Goodwood Blvd.
Suite #D1
Baton Rouge, LA 70806
Grant Number
NH25PS005176
Participating Start Date
7/13/2020
Last Recertification Date
5/21/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
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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