Contract Pharmacy Details

OPTUM FRONTIER THERAPIES II, LLC
DSH510007 ST. MARYS MEDICAL CENTER INC.

Covered Entity Details

Entity Name

ST. MARYS MEDICAL CENTER INC.

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH510007

Entity Address

2900 FIRST AVENUE
HUNTINGTON, WV 25702-1241

Medicare Provider Number

510007

Participating Start Date

7/1/2016

Last Recertification Date

9/5/2024

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

10/14/2020

Contract Begin Date

1/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/1/2020
Pharmacy closed

Contacts

Covered Entity Signing Official

Angela Swearingen, VP Finance/CFO
(304) 526-1224

Contract Pharmacy Representative

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

Signed By Date

10/14/2020

340B Drug Pricing Program Database