Contract Pharmacy Details

OPTUM PHARMACY 701, LLC
RWI900152E AIDS Healthcare Foundation

Covered Entity Details

Entity Name

AIDS Healthcare Foundation

Subdivision Name

AHF Healthcare Center - Riverside

Type

Ryan White Part A

340B ID

RWI900152E

Entity Address

4510 Brockton Avenue
Suite 350
Riverside, CA 92501

Grant Number

H89HA00032

Participating Start Date

7/1/2019

Last Recertification Date

2/20/2025

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

340B Drug Pricing Program Database