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OPTUM FRONTIER THERAPIES II, LLC
DSH050454 UCSF-MEDICAL CENTER
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Covered Entity Details
Entity Name
UCSF-MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050454
Entity Address
505 PARNASSUS AVE.
SAN FRANCISCO, CA 94143
Medicare Provider Number
050454
Participating Start Date
7/1/1993
Last Recertification Date
8/16/2024
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
1/9/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/23/2020
Pharmacy closed
Contacts
Covered Entity Signing Official
Sheila Antrum, SVP-AdultSvcs/President-MedCtr
(415) 353-2717
Contract Pharmacy Representative
Briova Rx
Joe Iovino, Manager
(412) 445-4495
Signed By Date
1/9/2018
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