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OPTUM FRONTIER THERAPIES II, LLC
FQHCLA397D Health Service Alliance
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Covered Entity Details
Entity Name
Health Service Alliance
Subdivision Name
Alta Loma Community Health Center
Type
Health Center Program Look-Alike
340B ID
FQHCLA397D
Entity Address
9089 Baseline Road STE 200
Rancho Cucamonga, CA 91730-1295
Grant Number
LALCS33333
Participating Start Date
10/1/2023
Last Recertification Date
3/6/2025
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
4/16/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Christen Grelling, Chief Operations Officer
(909) 464-9675 Ext: 104
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/16/2025
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