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OPTUM PHARMACY 806, INC.
RWI891041A John Phoenix APRN, PLLC
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Covered Entity Details
Entity Name
John Phoenix APRN, PLLC
Subdivision Name
Type
Ryan White Part A
340B ID
RWI891041A
Entity Address
The Gay and Lesbian Center of Southern Nevada
401 S. Maryland Parkway
Las Vegas, NV 89101
Grant Number
H89HA06900
Participating Start Date
4/1/2020
Last Recertification Date
Entity Termination Date
4/1/2021
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 806, INC.
Pharmacy Address
2288 AUBURN BLVD
STE. 102
SACRAMENTO, CA 95821-1618
Pharmacy Comments
Contract Details
Approval Date
7/13/2020
Contract Begin Date
7/13/2020
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
7/13/2020
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