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OPTUM FRONTIER THERAPIES II, LLC
DSH210009 JOHNS HOPKINS HOSPITAL
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Covered Entity Details
Entity Name
JOHNS HOPKINS HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH210009
Entity Address
600 NORTH WOLFE STREET
BALTIMORE, MD 21287
Medicare Provider Number
210009
Participating Start Date
7/1/2002
Last Recertification Date
9/4/2024
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
7/14/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Katina Williams, VP CFO
(410) 502-5388
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
7/14/2023
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