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OPTUM PHARMACY 702, LLC
STD71111 Gastrointestinal Specialists AMC
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Covered Entity Details
Entity Name
Gastrointestinal Specialists AMC
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD71111
Entity Address
2400 Hospital Drive
Suite 370
Bossier City, LA 71111
Grant Number
NU62PS924522
Participating Start Date
10/1/2024
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
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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