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OPTUM FRONTIER THERAPIES II, LLC
DSH060001 Banner North Colorado Medical Center
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Covered Entity Details
Entity Name
Banner North Colorado Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH060001
Entity Address
1801 16th Street
Greeley, CO 80631
Medicare Provider Number
060001
Participating Start Date
10/1/2013
Last Recertification Date
9/3/2024
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
7/14/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Matthew P Huff, CFO
(480) 543-2277
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
7/14/2020
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