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OPTUM PHARMACY 702, LLC
STD705704 Acadiana Practitioners' Specialty Clinic
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Covered Entity Details
Entity Name
Acadiana Practitioners' Specialty Clinic
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD705704
Entity Address
1200 Hospital Drive STE 4
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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