Contract Pharmacy Details

OPTUM INFUSION SERVICES 500, INC.
HM89178 Hemostasis and Thrombosis Center of Nevada

Covered Entity Details

Entity Name

Hemostasis and Thrombosis Center of Nevada

Subdivision Name

Type

Comprehensive Hemophilia Treatment Center

340B ID

HM89178

Entity Address

8352 W. Warm Springs Rd.
Suite 200
Las Vegas, NV 89113

Grant Number

H30MC24045

Participating Start Date

4/1/2018

Last Recertification Date

2/12/2025

Pharmacy Details

Pharmacy Name

OPTUM INFUSION SERVICES 500, INC.

Pharmacy Address

4900 RIVERGRADE RD STE E120
IRWINDALE, CA 91706-1419

Pharmacy Comments

Contract Details

Approval Date

7/7/2021

Contract Begin Date

7/16/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

8/11/2022
Pharmacy closed

Contacts

Covered Entity Signing Official

Jerry Fox, CFO
(702) 960-5373

Contract Pharmacy Representative

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

Signed By Date

7/7/2021

340B Drug Pricing Program Database