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OPTUM FRONTIER THERAPIES II, LLC
CAH461333-00 IHC Health Services Inc. DBA Intermountain Health Garfield Memorial Hospital
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Covered Entity Details
Entity Name
IHC Health Services Inc. DBA Intermountain Health Garfield Memorial Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH461333-00
Entity Address
200 North 400 East
Panguitch, UT 84759
Medicare Provider Number
461333
Participating Start Date
7/1/2017
Last Recertification Date
8/19/2024
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
Alberto Vasquez, Administrator
(435) 676-1261
Contract Pharmacy Representative
Optum RX
Joseph Iovino, VP
(412) 445-4495
Signed By Date
4/15/2019
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