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OPTUM FRONTIER THERAPIES II, LLC
DSH030115 BANNER ESTRELLA MEDICAL CENTER
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Covered Entity Details
Entity Name
BANNER ESTRELLA MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH030115
Entity Address
9201 WEST THOMAS ROAD
PHOENIX, AZ 85037
Medicare Provider Number
030115
Participating Start Date
7/1/2007
Last Recertification Date
8/19/2024
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
4/4/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ana Barraza, CFO
(480) 543-2277
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/4/2022
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