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OPTUM FRONTIER THERAPIES II, LLC
STD78721 Center for Health Empowerment
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Covered Entity Details
Entity Name
Center for Health Empowerment
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD78721
Entity Address
2312 Western Trails Blvd
Ste 103
Austin, TX 78745
Grant Number
NH25PS005182
Participating Start Date
7/1/2018
Last Recertification Date
5/5/2025
Pharmacy Details
Pharmacy Name
OPTUM FRONTIER THERAPIES II, LLC
Pharmacy Address
6425 SANTA MARGARITA ST UNIT 110
LAS VEGAS, NV 89118-1913
Pharmacy Comments
Contract Details
Approval Date
7/16/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/14/2021
Pharmacy closed
Contacts
Covered Entity Signing Official
Valerie Agee, Chief Operations Officer
(512) 840-1273
Contract Pharmacy Representative
Briova Rx
Joe Iovino, Manager
(412) 445-4495
Signed By Date
7/16/2018
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