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OPTUM FRONTIER THERAPIES, LLC
DSH220163BD UMASS MEMORIAL MEDICAL CENTER
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Covered Entity Details
Entity Name
UMASS MEMORIAL MEDICAL CENTER
Subdivision Name
Tri River other Ancillary
Type
Disproportionate Share Hospital
340B ID
DSH220163BD
Entity Address
281 east hartford ave
uxbridge, MA 01569
Medicare Provider Number
220163
Outpatient Facility Provider Number
220163
Participating Start Date
10/1/2014
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
OPTUM FRONTIER THERAPIES, LLC
Pharmacy Address
325 W ATHERTON RD
SUITE 1
FLINT, MI 48507-2601
Pharmacy Comments
Contract Details
Approval Date
7/17/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/3/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Alice Shakman, Vice President Operations
(774) 443-0540
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
7/17/2023
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