Once the pad is approximately placed, you can always enter the exact coordinates in the PCBLIB Inspector.
Once you have one pad placed exactly, copy and paste a second one on top of it (make sure the top layer is active so you can snap to pad centers), then with the second selected, M->"Move Selection by X, Y" and enter the required X/Y offset. Once you have two pads placed the appropriate distance apart, select Pad 2, Ctrl+C, select the center of Pad 1 as the base point . Then Ctrl+V, and snap to the center of Pad 2, which will place Pad 3 the same distance from Pad 2 as Pad 2 is from Pad 1. (Copy & paste in Altium's PCB editor works like AutoCAD's COPYBASE command, if you're familiar with that, so you can use it to paste with a known offset fairly easily based on existing geometry).
Or you can set your grid to the required spacing. G,G will set an arbitrary grid spacing in both X and Y in metric or imperial terms, G,Y,G to set an arbitrary Y grid spacing, G,X,G for the X. G,M will invoke the grid manager where you can do all sorts of crazy grid stuff, like piecewise grids of different pitches and polar grids.