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OPTUM FRONTIER THERAPIES II, LLC
HM441061 University Hospitals Cleveland Medical Center
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Covered Entity Details
Entity Name
University Hospitals Cleveland Medical Center
Subdivision Name
Hemophilia Treatment Center
Type
Comprehensive Hemophilia Treatment Center
340B ID
HM441061
Entity Address
11100 Euclid Ave, Mailstop 6054
Cleveland, OH 44106
Grant Number
H30MC24047
Participating Start Date
4/1/2020
Last Recertification Date
2/23/2025
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
4/16/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/5/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Michael R. Vehovec, Corporate Controller
(216) 767-8729
Contract Pharmacy Representative
Avella/BriovaRx
Paul Leschinert, National Account Manager,340B Sales
(847) 409-0200
Signed By Date
4/16/2020
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