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OPTUM PHARMACY 701, LLC
RWI20036 Washington Health Institute
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Covered Entity Details
Entity Name
Washington Health Institute
Subdivision Name
Infectious diseases
Type
Ryan White Part A
340B ID
RWI20036
Entity Address
1330 New Hampshire Ave NW
121
Washington, DC 20036
Grant Number
H89HA00012
Participating Start Date
12/1/2022
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 701, LLC
Pharmacy Address
1830 S HORNE
MESA, AZ 85204
Pharmacy Comments
Contract Details
Approval Date
1/15/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jose Bordon, Chief Executive Officer
(240) 426-8890
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
1/15/2025
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