Contract Pharmacy Details

OPTUM INFUSION SERVICES 305, LLC
STD891494 LifeCare Partners

Covered Entity Details

Entity Name

LifeCare Partners

Subdivision Name

HMGBD Medical

Type

Sexually Transmitted Diseases

340B ID

STD891494

Entity Address

5550 Painted Mirage Rd.
#1100
Las Vegas, NV 89149

Grant Number

6 NH25PS005179-05-03

Participating Start Date

7/1/2024

Last Recertification Date

Pharmacy Details

Pharmacy Name

OPTUM INFUSION SERVICES 305, LLC

Pharmacy Address

15529 COLLEGE BLVD.
LENEXA, KS 66219-1351

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

Vladimir Abadjiev, COO
(702) 526-3146

Contract Pharmacy Representative

Optum
Avani Patel, VP, 340B Operations
(763) 330-5555

Signed By Date

4/15/2025

340B Drug Pricing Program Database