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OPTUM FRONTIER THERAPIES II, LLC
DSH170040 UNIVERSITY OF KANSAS HOSPITAL
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Covered Entity Details
Entity Name
UNIVERSITY OF KANSAS HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH170040
Entity Address
4000 Cambridge Street
Kansas City, KS 66160
Medicare Provider Number
170040
Participating Start Date
10/1/2000
Last Recertification Date
9/6/2024
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
10/11/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/5/2021
Pharmacy closed
Contacts
Covered Entity Signing Official
Rick Couldry, Vice-President, Pharmacy and Clinical Professions
(913) 588-2301
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/11/2019
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