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OPTUM FRONTIER THERAPIES II, LLC
RRC460010-00 IHC Health Services Inc. dba INTERMOUNTAIN HEALTH INTERMOUNTAIN MEDICAL CENTER
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Covered Entity Details
Entity Name
IHC Health Services Inc. dba INTERMOUNTAIN HEALTH INTERMOUNTAIN MEDICAL CENTER
Subdivision Name
Type
Rural Referral Center
340B ID
RRC460010-00
Entity Address
5121 S COTTONWOOD ST
MURRAY, UT 84107
Medicare Provider Number
460010
Participating Start Date
6/8/2022
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
4/17/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Nathan Empey, Director of Finance
(801) 357-7049
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/17/2025
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