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OPTUM FRONTIER THERAPIES II, LLC
DSH060107 NATIONAL JEWISH MEDICAL AND RESEARCH CENTER
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Covered Entity Details
Entity Name
NATIONAL JEWISH MEDICAL AND RESEARCH CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH060107
Entity Address
1400 JACKSON STREET
DENVER, CO 80206
Medicare Provider Number
060107
Participating Start Date
10/1/2004
Last Recertification Date
9/3/2024
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
11/4/2020
Pharmacy closed
Contacts
Covered Entity Signing Official
CHRISTINE FORKNER, CFO
(303) 398-1004
Contract Pharmacy Representative
Briova
Joseph L Lovino, Manager, 340B Specialty Program
(412) 445-4495
Signed By Date
1/12/2018
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