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OPTUM INFUSION SERVICES 500, INC.
RW431241 San Antonio AIDS Foundation
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Covered Entity Details
Entity Name
San Antonio AIDS Foundation
Subdivision Name
Type
Ryan White Part D
340B ID
RW431241
Entity Address
818 E. Grayson St.
San Antonio, TX 78208
Grant Number
H12HA31241
Participating Start Date
4/1/2019
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
OPTUM INFUSION SERVICES 500, INC.
Pharmacy Address
4620 S SAM HOUSTON PKWY W STE 440
HOUSTON, TX 77053
Pharmacy Comments
Contract Details
Approval Date
10/4/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/15/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Cherise Rohr-Allegrini, Chief Executive Officer
(210) 225-4715 Ext: 122
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/4/2022
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