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OPTUM FRONTIER THERAPIES II, LLC
CAH461300-00 IHC Health Services, INC. DBA: INTERMOUNTAIN HEALTH DELTA COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
IHC Health Services, INC. DBA: INTERMOUNTAIN HEALTH DELTA COMMUNITY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH461300-00
Entity Address
126 S WHITE SAGE AVE
DELTA, UT 84624
Medicare Provider Number
461300
Participating Start Date
10/1/2014
Last Recertification Date
8/20/2024
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
4/15/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/27/2020
Pharmacy closed
Contacts
Covered Entity Signing Official
Lenny Lyons, Administrator--Delta Community Medical Center
(435) 864-1510
Contract Pharmacy Representative
Optum RX
Joseph Iovino, VP
(412) 445-4495
Signed By Date
4/15/2019
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