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OPTUM FRONTIER THERAPIES II, LLC
STD78216 Texas Health Action
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Covered Entity Details
Entity Name
Texas Health Action
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD78216
Entity Address
730 Isom Road
San Antonio, TX 78216
Grant Number
NH25PS005182
Participating Start Date
10/1/2017
Last Recertification Date
5/28/2024
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
7/15/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Christopher M Hamilton, CEO
(512) 647-6512
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
7/15/2020
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