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OPTUM FRONTIER THERAPIES II, LLC
STD85004 Prisma Community Care
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Covered Entity Details
Entity Name
Prisma Community Care
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD85004
Entity Address
1101 N Central Ave
Suite 200
Phoenix, AZ 85004
Grant Number
5 NU62PS924676-03-00
Participating Start Date
1/1/2019
Last Recertification Date
5/8/2024
Pharmacy Details
Pharmacy Name
OPTUM FRONTIER THERAPIES II, LLC
Pharmacy Address
6425 SANTA MARGARITA ST UNIT 120
LAS VEGAS, NV 89118
Pharmacy Comments
Contract Details
Approval Date
4/7/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/12/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Jessyca Leach, Executive Director
(602) 595-8115
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/7/2022
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