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OPTUM FRONTIER THERAPIES II, LLC
FQHCLA225 Maricopa County Special Health Care District
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Covered Entity Details
Entity Name
Maricopa County Special Health Care District
Subdivision Name
Type
Health Center Program Look-Alike
340B ID
FQHCLA225
Entity Address
2601 E. ROOSEVELT STREET
PHOENIX, AZ 85008
Grant Number
LALCS00037
Participating Start Date
10/1/2007
Last Recertification Date
2/15/2019
Entity Termination Date
4/1/2020
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
10/16/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Kris Gaw, Chief Operating Officer
(602) 344-1258
Contract Pharmacy Representative
Briova Rx
Joe Iovino, Manager
(412) 445-4495
Signed By Date
10/16/2017
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