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OPTUM FRONTIER THERAPIES II, LLC
DSH310064 ATLANTICARE REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
ATLANTICARE REGIONAL MEDICAL CENTER
Subdivision Name
CITY DIVISION
Type
Disproportionate Share Hospital
340B ID
DSH310064
Entity Address
1925 PACIFIC AVENUE
ATLANTIC CITY, NJ 08401
Medicare Provider Number
310064
Participating Start Date
7/1/2012
Last Recertification Date
8/19/2024
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
4/14/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Hak Kim, Chief Financial Officer
(609) 569-7031
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/14/2020
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