Contract Pharmacy Details

OPTUM PHARMACY 701, LLC
RWI917301 AIDS HEALTHCARE FOUNDATION

Covered Entity Details

Entity Name

AIDS HEALTHCARE FOUNDATION

Subdivision Name

AHF HEALTHCARE CENTER - UPLAND

Type

Ryan White Part A

340B ID

RWI917301

Entity Address

8263 GROVE AVE
SUITE 201
RANCHO CUCAMONGA, CA 91730

Grant Number

H89HA00032

Participating Start Date

7/1/2005

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