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OPTUM FRONTIER THERAPIES II, LLC
DSH500044 DEACONESS MEDICAL CENTER
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Covered Entity Details
Entity Name
DEACONESS MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH500044
Entity Address
800 W 5TH AVENUE
SPOKANE, WA 99204
Medicare Provider Number
500044
Participating Start Date
1/1/2019
Last Recertification Date
8/18/2024
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
4/11/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/21/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Wendy Hunter Apland, Chief Financial Officer
(509) 473-7961
Contract Pharmacy Representative
Avella
Nancy McCutcheon, Senior Vice President, Strategic Services
(651) 983-0677
Signed By Date
4/11/2019
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