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OPTUM FRONTIER THERAPIES II, LLC
DSH220031 BOSTON MEDICAL CENTER
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Covered Entity Details
Entity Name
BOSTON MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH220031
Entity Address
1 Boston Medical Center Place
BOSTON, MA 02118
Medicare Provider Number
220031
Participating Start Date
12/1/1992
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
10/16/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2020
Pharmacy closed
Contacts
Covered Entity Signing Official
Kathleen E. Walsh, Chief Executive Officer
(617) 638-6911
Contract Pharmacy Representative
Briova Rx
Joe Iovino, Manager
(412) 445-4495
Signed By Date
10/16/2017
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