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OPTUM FRONTIER THERAPIES II, LLC
RRC220071-00 MASSACHUSETTS GENERAL HOSPITAL
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Covered Entity Details
Entity Name
MASSACHUSETTS GENERAL HOSPITAL
Subdivision Name
The General Hospital Corporation
Type
Rural Referral Center
340B ID
RRC220071-00
Entity Address
55 FRUIT STREET
BOSTON, MA 02114
Medicare Provider Number
220071
Participating Start Date
1/1/2020
Last Recertification Date
9/7/2020
Entity Termination Date
3/24/2021
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
7/15/2020
Contract Begin Date
7/23/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/13/2021
Pharmacy closed
Contacts
Covered Entity Signing Official
O'Neil Britton, M.D., Chief Medical Officer, Senior Vice President Administration
(617) 724-1276
Contract Pharmacy Representative
Massachusetts General Hospital
Rafic Nehme, Director, Pharmacy Business & Finance
(617) 726-5125
Signed By Date
7/15/2020
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