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OPTUM PHARMACY 702, LLC
RWI11432 AIDS Center of Queens County, Inc.
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Covered Entity Details
Entity Name
AIDS Center of Queens County, Inc.
Subdivision Name
Type
Ryan White Part A
340B ID
RWI11432
Entity Address
161-21 Jamaica Avenue, 6th Floor
Jamaica, NY 11432-6113
Grant Number
H89HA00015
Participating Start Date
10/1/2013
Last Recertification Date
2/24/2025
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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