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OPTUM PHARMACY 702, LLC
STD85719 Southern Arizona AIDS Foundation
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Covered Entity Details
Entity Name
Southern Arizona AIDS Foundation
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD85719
Entity Address
375 S Euclid
Tucson, AZ 85719
Grant Number
NU62PS924675-01-00
Participating Start Date
1/1/2022
Last Recertification Date
5/6/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
10/13/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Beth A Frantz, CEO
(520) 547-6069
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/13/2023
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