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OPTUM PHARMACY 702, LLC
STD89101 The Gay and Lesbian Community Center of Southern Nevada
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Covered Entity Details
Entity Name
The Gay and Lesbian Community Center of Southern Nevada
Subdivision Name
Southern Nevada Health District
Type
Sexually Transmitted Diseases
340B ID
STD89101
Entity Address
401 S. Maryland Pkwy
Las Vegas, NV 89101
Grant Number
NH25PS005179
Participating Start Date
4/1/2020
Last Recertification Date
5/10/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
4/15/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Vince Collins, Director of Operations
(702) 802-5410 Ext: 7028025410
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/15/2020
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