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OPTUM FRONTIER THERAPIES II, LLC
DSH230029 TRINITY HEALTH OAKLAND HOSPITAL
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Covered Entity Details
Entity Name
TRINITY HEALTH OAKLAND HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230029
Entity Address
44405 WOODWARD AVENUE
PONTIAC, MI 48341
Medicare Provider Number
230029
Participating Start Date
7/1/2022
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
1/7/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/2/2021
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Michael Gusho, Regional Chief Financial Officer
(248) 858-6174
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
1/7/2020
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