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OPTUM FRONTIER THERAPIES II, LLC
CAH491304-00 CARILION ROCKBRIDGE COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
CARILION ROCKBRIDGE COMMUNITY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH491304-00
Entity Address
1 HEALTH CIRCLE
LEXINGTON, VA 24450
Medicare Provider Number
491304
Participating Start Date
8/30/2010
Last Recertification Date
9/5/2024
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
5/18/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Greg Todd Madsen, VP
(540) 458-3590
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
5/18/2020
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