Contract Pharmacy Details

OPTUM FRONTIER THERAPIES II, LLC
DSH050438 HUNTINGTON HOSPITAL

Covered Entity Details

Entity Name

HUNTINGTON HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH050438

Entity Address

100 W. California Blvd
Pasadena, CA 91105

Medicare Provider Number

050438

Participating Start Date

7/1/2019

Last Recertification Date

8/30/2024

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

Contract Termination Date
Termination Reason

5/18/2022
Pharmacy closed

Contacts

Covered Entity Signing Official

Steven Mohr, Senior Vice President & Chief Financial Officer
(626) 397-5555

Contract Pharmacy Representative

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

Signed By Date

5/18/2020

340B Drug Pricing Program Database