Contract Pharmacy Details

OPTUM FRONTIER THERAPIES II, LLC
DSH360134 THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO

Covered Entity Details

Entity Name

THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OHIO

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH360134

Entity Address

375 DIXMYTH AVE
CINCINNATI, OH 45220

Medicare Provider Number

360134

Participating Start Date

4/1/2006

Last Recertification Date

8/20/2024

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

4/13/2020

Contract Begin Date

7/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/31/2021
Pharmacy closed

Contacts

Covered Entity Signing Official

Michael Crofton, Sr. Vice President & CFO
(513) 569-6577

Contract Pharmacy Representative

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

Signed By Date

4/13/2020

340B Drug Pricing Program Database