Contract Pharmacy Details

OPTUM FRONTIER THERAPIES II, LLC
DSH050348 UCI MEDICAL CENTER

Covered Entity Details

Entity Name

UCI MEDICAL CENTER

Subdivision Name

UNIVERSITY OF CALIFORNIA, IRVINE

Type

Disproportionate Share Hospital

340B ID

DSH050348

Entity Address

101 THE CITY DR. S RT32
ORANGE, CA 92868

Medicare Provider Number

050348

Participating Start Date

1/1/1998

Last Recertification Date

8/29/2024

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

10/13/2017

Contract Begin Date

1/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

8/1/2023
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Howard Federoff, CEO & Vice Chancellor, Health Affairs
(949) 824-5926

Contract Pharmacy Representative

Avella
Nancy McCutcheon, Senior Vice President, Strategic Services
(651) 983-0677

Signed By Date

10/13/2017

340B Drug Pricing Program Database