Contract Pharmacy Details

OPTUM PHARMACY 702, LLC
HV01710D AIDS ARMS, INC. d/b/a Prism Health North Texas

Covered Entity Details

Entity Name

AIDS ARMS, INC. d/b/a Prism Health North Texas

Subdivision Name

Worth Street

Type

Ryan White Part C

340B ID

HV01710D

Entity Address

4004 Worth Street
Suite 100
Dallas, TX 75246

Grant Number

H76HA01710

Participating Start Date

4/1/2021

Last Recertification Date

3/3/2025

Pharmacy Details

Pharmacy Name

OPTUM PHARMACY 702, LLC

Pharmacy Address

1050 PATROL RD
JEFFERSONVILLE, IN 47130

Pharmacy Comments

Contract Details

Approval Date

7/26/2021

Contract Begin Date

8/27/2021

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

John T. Carlo, CEO
(214) 521-5191

Contract Pharmacy Representative

Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677

Signed By Date

7/26/2021

340B Drug Pricing Program Database