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OPTUM PHARMACY 705, LLC
STD71103 Gastrointestinal Specialists AMC
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Covered Entity Details
Entity Name
Gastrointestinal Specialists AMC
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD71103
Entity Address
3217 Mabel Street
Shreveport, LA 71103
Grant Number
NH25PS005176
Participating Start Date
10/1/2024
Last Recertification Date
5/13/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 705, LLC
Pharmacy Address
1100 LEE BRANCH LN
BIRMINGHAM, AL 35242-7298
Pharmacy Comments
Contract Details
Approval Date
4/14/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Adi Darsi, CEO
(318) 213-4536
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
4/14/2025
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