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OPTUM PHARMACY 701, LLC
STD708091 AIDS Healthcare Foundation
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Covered Entity Details
Entity Name
AIDS Healthcare Foundation
Subdivision Name
AHF Healthcare Center - Baton Rouge (Azmeh)
Type
Sexually Transmitted Diseases
340B ID
STD708091
Entity Address
4890 Bluebonnet Blvd.
Baton Rouge, LA 70809-9649
Grant Number
NH25PS005176
Participating Start Date
7/13/2020
Last Recertification Date
5/14/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 701, LLC
Pharmacy Address
1830 S HORNE
MESA, AZ 85204
Pharmacy Comments
Contract Details
Approval Date
7/5/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Rena DeStefano, Director of Pharmacy Finance
(631) 370-2022
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
7/5/2024
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