Contract Pharmacy Details

OPTUM FRONTIER THERAPIES II, LLC
SCH520019-00 ASPIRUS RHINELANDER HOSPITAL

Covered Entity Details

Entity Name

ASPIRUS RHINELANDER HOSPITAL

Subdivision Name

Type

Sole Community Hospital

340B ID

SCH520019-00

Entity Address

2251 NORTH SHORE DRIVE
STE 100
RHINELANDER, WI 54501

Medicare Provider Number

520019

Participating Start Date

10/1/2024

Last Recertification Date

Entity Termination Date

4/1/2025

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

7/9/2020

Contract Begin Date

10/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/1/2020
Pharmacy closed

Contacts

Covered Entity Signing Official

Laurie Oungst, Chief Administrative Officer
(715) 356-8560

Contract Pharmacy Representative

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

Signed By Date

7/9/2020

340B Drug Pricing Program Database