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OPTUM FRONTIER THERAPIES II, LLC
DSH140091 The Carle Foundation Hospital
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Covered Entity Details
Entity Name
The Carle Foundation Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140091
Entity Address
611 West Park Street
Urbana, IL 61801
Medicare Provider Number
140091
Participating Start Date
10/1/2012
Last Recertification Date
9/4/2024
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
1/12/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/15/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Dennis P. Hesch, Executive VP and CFO
(217) 326-8231
Contract Pharmacy Representative
Briova Rx
Joe Iovino, Manager
(412) 445-4495
Signed By Date
1/12/2018
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