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OPTUM FRONTIER THERAPIES II, LLC
PED453316-00 Children’s Medical Center Plano
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Covered Entity Details
Entity Name
Children’s Medical Center Plano
Subdivision Name
Type
Children's Hospital
340B ID
PED453316-00
Entity Address
7601 Preston Road
Plano, TX 75024-3214
Medicare Provider Number
453316
Participating Start Date
4/1/2017
Last Recertification Date
8/13/2024
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
7/13/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
David T Berry, CHST President, System Clinical Operations
(214) 456-2143
Contract Pharmacy Representative
Avella
Nancy McCutcheon, Sr VP of Strategic Sales
(651) 983-0677
Signed By Date
7/13/2020
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