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OPTUM PHARMACY 702, LLC
STD70461 Hilton Dermatology and Aesthetics
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Covered Entity Details
Entity Name
Hilton Dermatology and Aesthetics
Subdivision Name
Hilton Dermatology and Aesthetics
Type
Sexually Transmitted Diseases
340B ID
STD70461
Entity Address
2050 Gause Blvd E, Suite 100
Slidell, LA 70461
Grant Number
NH25PS005176
Participating Start Date
4/1/2024
Last Recertification Date
5/5/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
4/10/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
angel barrios, practice manager
(985) 649-5880
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
4/10/2025
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