Contract Pharmacy Details

OPTUM FRONTIER THERAPIES, LLC
DSH520078 Ascension St. Francis Hospital, Inc.

Covered Entity Details

Entity Name

Ascension St. Francis Hospital, Inc.

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH520078

Entity Address

3237 SOUTH 16TH STREET
MILWAUKEE, WI 53215

Medicare Provider Number

520078

Participating Start Date

10/1/2006

Last Recertification Date

8/22/2024

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

9/14/2023

Contract Begin Date

10/1/2023

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Vanessa Freitag, Vice President, Pharmacy
(715) 897-1183

Contract Pharmacy Representative

Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677

Signed By Date

9/14/2023

340B Drug Pricing Program Database