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OPTUM FRONTIER THERAPIES, LLC
DSH210002 UNIVERSITY OF MARYLAND MEDICAL CENTER
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Covered Entity Details
Entity Name
UNIVERSITY OF MARYLAND MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH210002
Entity Address
22 SOUTH GREENE STREET
BALTIMORE, MD 21201
Medicare Provider Number
210002
Participating Start Date
10/1/2001
Last Recertification Date
8/20/2024
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
4/4/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/9/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Joseph Dicubellis, Senior Director of Pharmacy
(410) 328-6746
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/4/2024
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