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OPTUM FRONTIER THERAPIES II, LLC
CAH141315-00 Illini Community Hospital
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Covered Entity Details
Entity Name
Illini Community Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH141315-00
Entity Address
640 W. Washington Street
Pittsfield, IL 62363
Medicare Provider Number
141315
Participating Start Date
1/1/2014
Last Recertification Date
8/12/2024
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
10/8/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/23/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kathy Hull, President/CEO
(217) 285-2113 Ext: 3803
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/8/2019
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