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OPTUM FRONTIER THERAPIES II, LLC
CHC08238-00 CHANGE, INCORPORATED
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Covered Entity Details
Entity Name
CHANGE, INCORPORATED
Subdivision Name
Family Medical Care Community Health Center - Hancock County
Type
HRSA-Funded Health Center
340B ID
CHC08238-00
Entity Address
3136 West St
Weirton, WV 26062-4637
Grant Number
H80CS08238
Participating Start Date
4/1/2007
Last Recertification Date
2/11/2025
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
4/15/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/31/2020
Pharmacy closed
Contacts
Covered Entity Signing Official
Judy Raveaux, CEO
(304) 797-7733 Ext: 1311
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/15/2020
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