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OPTUM FRONTIER THERAPIES II, LLC
DSH220066 MERCY MEDICAL CENTER
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Covered Entity Details
Entity Name
MERCY MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH220066
Entity Address
271 CAREW STREET
SPRINGFIELD, MA 01104
Medicare Provider Number
220066
Participating Start Date
7/1/2004
Last Recertification Date
8/23/2024
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
10/23/2020
Pharmacy closed
Contacts
Covered Entity Signing Official
Stuart Edward Rosenberg, Vice President of Operations
(413) 748-9008
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/15/2019
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