Contract Pharmacy Details

OPTUM FRONTIER THERAPIES II, LLC
DSH500064 HARBORVIEW MEDICAL CENTER

Covered Entity Details

Entity Name

HARBORVIEW MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH500064

Entity Address

325 9TH AVE.
SEATTLE, WA 98104-2499

Medicare Provider Number

500064

Participating Start Date

12/1/1992

Last Recertification Date

8/28/2024

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

10/8/2020

Contract Begin Date

10/13/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/12/2021
Pharmacy closed

Contacts

Covered Entity Signing Official

MAUREEN BROOM, Enterprise Finance Officer
(206) 598-5362

Contract Pharmacy Representative

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

Signed By Date

10/8/2020

340B Drug Pricing Program Database