Contract Pharmacy Details

OPTUM FRONTIER THERAPIES II, LLC
RWI891041 John Phoenix APRN PLLC

Covered Entity Details

Entity Name

John Phoenix APRN PLLC

Subdivision Name

Huntridge Family Clinic/CAN Community Health

Type

Ryan White Part A

340B ID

RWI891041

Entity Address

1820 E. Sahara Ave
Suite 201
Las Vegas, NV 89104

Grant Number

H89HA06900

Participating Start Date

7/1/2022

Last Recertification Date

1/31/2023

Entity Termination Date

1/1/2024

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

1/6/2020

Contract Begin Date

4/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2021
Covered Entity Terminated

Contacts

Covered Entity Signing Official

John Phoenix, Chief Clinical Officer
(702) 979-1111

Contract Pharmacy Representative

Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677

Signed By Date

1/6/2020

340B Drug Pricing Program Database