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OPTUM FRONTIER THERAPIES II, LLC
SCH460007-00 IHC HEALTH SERVICES, INC. DBA: CEDAR CITY HOSPITAL
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Covered Entity Details
Entity Name
IHC HEALTH SERVICES, INC. DBA: CEDAR CITY HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH460007-00
Entity Address
1303 NORTH MAIN
CEDAR CITY, UT 84720
Medicare Provider Number
460007
Participating Start Date
10/1/2019
Last Recertification Date
Entity Termination Date
7/1/2020
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
8/5/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/3/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Craig Dale Corry, Finance Director
(435) 868-5819
Contract Pharmacy Representative
Optum RX
Joseph Iovino, VP
(412) 445-4495
Signed By Date
7/9/2019
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