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OPTUM PHARMACY 702, LLC
STD705703 Acadiana Practitioners' Gastro Clinic
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Covered Entity Details
Entity Name
Acadiana Practitioners' Gastro Clinic
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD705703
Entity Address
331 South Main Street
Opelousas, LA 70570
Grant Number
NH25PS005176
Participating Start Date
7/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
5/2/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Rhonda Bergeron, CEO
(337) 447-4027
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
4/9/2025
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