Contract Pharmacy Details

OPTUM FRONTIER THERAPIES II, LLC
DSH050006 St. Joseph Health Northern California, LLC-DBA St. Joseph Hospital

Covered Entity Details

Entity Name

St. Joseph Health Northern California, LLC-DBA St. Joseph Hospital

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH050006

Entity Address

2700 DOLBEER STREET
EUREKA, CA 95501

Medicare Provider Number

050006

Participating Start Date

4/1/2009

Last Recertification Date

8/16/2024

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

1/15/2020

Contract Begin Date

4/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

12/2/2020
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Kevin Klockenga, CEO
(707) 522-1520

Contract Pharmacy Representative

Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677

Signed By Date

1/15/2020

340B Drug Pricing Program Database