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OPTUM FRONTIER THERAPIES II, LLC
PED073300-00 CONNECTICUT CHILDREN'S MEDICAL CENTER
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Covered Entity Details
Entity Name
CONNECTICUT CHILDREN'S MEDICAL CENTER
Subdivision Name
Type
Children's Hospital
340B ID
PED073300-00
Entity Address
282 WASHINGTON STREET
HARTFORD, CT 06106
Medicare Provider Number
073300
Participating Start Date
7/1/2010
Last Recertification Date
8/26/2024
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
1/8/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Robert Elijah Duncan, Executive Vice President & Chief Operating Officer
(860) 545-8648
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
1/8/2024
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