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OPTUM FRONTIER THERAPIES II, LLC
RRC450032-00 GOOD SHEPHERD MEDICAL CENTER
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Covered Entity Details
Entity Name
GOOD SHEPHERD MEDICAL CENTER
Subdivision Name
Type
Rural Referral Center
340B ID
RRC450032-00
Entity Address
811 SOUTH WASHINGTON
MARSHALL, TX 75670
Medicare Provider Number
450032
Participating Start Date
11/30/2020
Last Recertification Date
8/18/2021
Entity Termination Date
7/1/2022
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
11/3/2020
Contract Begin Date
12/2/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Michael Cheek, CFO
(903) 315-1814
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/9/2020
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