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OPTUM FRONTIER THERAPIES II, LLC
DSH450137 BAYLOR SCOTT & WHITE ALL SAINTS MEDICAL CENTER - FORT WORTH
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Covered Entity Details
Entity Name
BAYLOR SCOTT & WHITE ALL SAINTS MEDICAL CENTER - FORT WORTH
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450137
Entity Address
1400 8TH AVENUE
FORT WORTH, TX 76104
Medicare Provider Number
450137
Participating Start Date
1/1/2010
Last Recertification Date
8/20/2024
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
7/15/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lucy Catala, VP CFO - DFW West Region
(817) 922-1957
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
7/15/2021
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