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OPTUM PHARMACY 702, LLC
STD71115 Gastrointestinal Specialists AMC
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Covered Entity Details
Entity Name
Gastrointestinal Specialists AMC
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD71115
Entity Address
8383 Millicent Way
Suite B
Shreveport, LA 71115
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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