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OPTUM FRONTIER THERAPIES II, LLC
SCH110025-00 SOUTHEAST GEORGIA REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
SOUTHEAST GEORGIA REGIONAL MEDICAL CENTER
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH110025-00
Entity Address
2415 PARKWOOD DRIVE
BRUNSWICK, GA 31520
Medicare Provider Number
110025
Participating Start Date
1/1/2016
Last Recertification Date
8/14/2024
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
10/15/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/13/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
MICHAEL SCHERNECK, CEO
(912) 466-7049
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/15/2019
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