Contract Pharmacy Details

OPTUM FRONTIER THERAPIES II, LLC
DSH230053 HENRY FORD HOSPITAL

Covered Entity Details

Entity Name

HENRY FORD HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH230053

Entity Address

2799 WEST GRAND BLVD
DETROIT, MI 48202

Medicare Provider Number

230053

Participating Start Date

10/1/2002

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

10/19/2016

Contract Begin Date

1/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/23/2020
Pharmacy closed

Contacts

Covered Entity Signing Official

Edward Chadwick, EVP, Finance and Admin & CFO
(313) 876-8714

Contract Pharmacy Representative

Optum
NATHAN WHITE, Vice President Sales - TPA & Hospital
(813) 949-1951

Signed By Date

10/19/2016

340B Drug Pricing Program Database