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OPTUM FRONTIER THERAPIES II, LLC
PED013301-00 USA Health Children's and Women's Hospital
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Covered Entity Details
Entity Name
USA Health Children's and Women's Hospital
Subdivision Name
Type
Children's Hospital
340B ID
PED013301-00
Entity Address
1700 Center Street
Mobile, AL 36604-3301
Medicare Provider Number
013301
Participating Start Date
7/1/2013
Last Recertification Date
8/21/2024
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
1/13/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Benny J Stover, USA Health, CFO
(251) 445-9164
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
1/13/2025
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