Contract Pharmacy Details

OPTUM PHARMACY 806, INC.
STD891011 John Phoenix APRN, PLLC

Covered Entity Details

Entity Name

John Phoenix APRN, PLLC

Subdivision Name

Huntridge Family Clinic

Type

Sexually Transmitted Diseases

340B ID

STD891011

Entity Address

The Gay and Lesbian Center
401 S. Maryland Parkway
Las Vegas, NV 89101

Grant Number

5 NH25PS005179-02-00

Participating Start Date

4/1/2020

Last Recertification Date

5/10/2021

Entity Termination Date

7/1/2022

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

7/1/2022
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

340B Drug Pricing Program Database