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OPTUM PHARMACY 702, LLC
RWI43222 AIDS HEALTHCARE FOUNDATION
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Covered Entity Details
Entity Name
AIDS HEALTHCARE FOUNDATION
Subdivision Name
AHF HEALTHCARE CENTER - COLUMBUS
Type
Ryan White Part A
340B ID
RWI43222
Entity Address
815 W. BROAD STREET, SUITE 350
COLUMBUS, OH 43222
Grant Number
H89HA25698
Participating Start Date
10/1/2013
Last Recertification Date
2/20/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
10/12/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Rena DeStefano, Director of Pharmacy Finance
(631) 370-2022
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/12/2022
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