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OPTUM PHARMACY 702, LLC
STD700723 Harris M. Blackman, MD, LLC
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Covered Entity Details
Entity Name
Harris M. Blackman, MD, LLC
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD700723
Entity Address
1111 Medical Center Boulevard
N-401
Marrero, LA 70072
Grant Number
NU62PS924522
Participating Start Date
4/1/2023
Last Recertification Date
5/6/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
4/15/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jennifer Ladd Bowman, Office Manager
(504) 347-2141 Ext: 1
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
4/15/2025
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