Contract Pharmacy Details

OPTUM PHARMACY 701, LLC
RWI44115 AIDS HEALTHCARE FOUNDATION

Covered Entity Details

Entity Name

AIDS HEALTHCARE FOUNDATION

Subdivision Name

AHF HEALTHCARE CENTER - CLEVELAND

Type

Ryan White Part A

340B ID

RWI44115

Entity Address

2829 EUCLID AVE.
CLEVELAND, OH 44115

Grant Number

H89HA23812

Participating Start Date

1/1/2016

Last Recertification Date

2/23/2024

Entity Termination Date

4/1/2025

Pharmacy Details

Pharmacy Name

OPTUM PHARMACY 701, LLC

Pharmacy Address

1830 S HORNE
MESA, AZ 85204

Pharmacy Comments

Contract Details

Approval Date

10/12/2024

Contract Begin Date

1/1/2025

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2025
Covered Entity Terminated

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

10/12/2024

340B Drug Pricing Program Database