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OPTUM PHARMACY 702, LLC
STD705033 Louisiana Gastroenterology Associates LLC
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Covered Entity Details
Entity Name
Louisiana Gastroenterology Associates LLC
Subdivision Name
Louisiana Gastroenterology Associates LLC
Type
Sexually Transmitted Diseases
340B ID
STD705033
Entity Address
439 Heymann Blvd
Lafayette, LA 70503
Grant Number
NU62PS924522
Participating Start Date
7/1/2023
Last Recertification Date
5/10/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
4/1/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Maneesh Gupta, CEO
(337) 322-2147
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
4/1/2025
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