Contract Pharmacy Details

OPTUM PHARMACY 702, LLC
RWI606161C AIDS Healthcare Foundation

Covered Entity Details

Entity Name

AIDS Healthcare Foundation

Subdivision Name

AHF Healthcare Center - Chicago (Hyde Park)

Type

Ryan White Part A

340B ID

RWI606161C

Entity Address

1515 East 52nd Place
Chicago, IL 60615-4390

Grant Number

H89HA00008

Participating Start Date

10/1/2018

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

10/13/2022

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

10/13/2022

340B Drug Pricing Program Database