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OPTUM FRONTIER THERAPIES II, LLC
DSH210029 JOHNS HOPKINS BAYVIEW MEDICAL CENTER
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Covered Entity Details
Entity Name
JOHNS HOPKINS BAYVIEW MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH210029
Entity Address
4940 EASTERN AVENUE
BALTIMORE, MD 21224
Medicare Provider Number
210029
Participating Start Date
10/1/2001
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
7/15/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brian Rayme, Chief Financial Officer
(443) 377-0616
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
7/15/2023
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