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OPTUM PHARMACY 701, LLC
STD85028 RSG Healthcare
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Covered Entity Details
Entity Name
RSG Healthcare
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD85028
Entity Address
11209 N Tatum BLVD
STE 185
Phoenix, AZ 85028
Grant Number
NU62PS924818
Participating Start Date
7/1/2024
Last Recertification Date
5/13/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 701, LLC
Pharmacy Address
8131 W BOSTIAN RD STE A350
WOODINVILLE, WA 98072-5029
Pharmacy Comments
Contract Details
Approval Date
4/2/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Randy S Gelow, Owner/Medical Doctor
(602) 669-2585
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
4/2/2025
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