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OPTUM PHARMACY 702, LLC
STD711012 Rheumatology and Osteoporosis Specialists
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Covered Entity Details
Entity Name
Rheumatology and Osteoporosis Specialists
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD711012
Entity Address
820 Jordan St #201
Shreveport, LA 71101
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
Aaron Broadwell, CEO/MD
(318) 221-0399
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
4/13/2025
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