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OPTUM PHARMACY 701, LLC
STD891013 The Gay and Lesbian Community Center of Southern Nevada
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Covered Entity Details
Entity Name
The Gay and Lesbian Community Center of Southern Nevada
Subdivision Name
Southern Nevada Health District
Type
Sexually Transmitted Diseases
340B ID
STD891013
Entity Address
921 S. Las Vegas Blvd
Las Vegas, NV 89101
Grant Number
NH25PS005179
Participating Start Date
7/1/2024
Last Recertification Date
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 701, LLC
Pharmacy Address
1830 S HORNE
MESA, AZ 85204
Pharmacy Comments
Contract Details
Approval Date
7/15/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
John Waldron, CEO
(702) 802-5400
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
7/15/2024
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