Contract Pharmacy Details

OPTUM FRONTIER THERAPIES II, LLC
CH090250 CLINICAS DE SALUD DEL PUEBLO,Inc.

Covered Entity Details

Entity Name

CLINICAS DE SALUD DEL PUEBLO,Inc.

Subdivision Name

Innercare K Street

Type

HRSA-Funded Health Center

340B ID

CH090250

Entity Address

1166 K St
Brawley, CA 92227-2737

Grant Number

H80CS00733

Participating Start Date

12/1/1992

Last Recertification Date

2/12/2025

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

9/8/2020

Contract Begin Date

9/9/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/23/2020
Pharmacy closed

Contacts

Covered Entity Signing Official

YVONNE BELL, CEO
(760) 344-9951 Ext: 10102

Contract Pharmacy Representative

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

Signed By Date

9/8/2020

340B Drug Pricing Program Database