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OPTUM FRONTIER THERAPIES II, LLC
HV01713 MetroHealth
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Covered Entity Details
Entity Name
MetroHealth
Subdivision Name
Type
Ryan White Part C
340B ID
HV01713
Entity Address
1012 14TH STREET, NW
SUITE 700
WASHINGTON, DC 20005
Grant Number
H89HA00012
Participating Start Date
7/1/2009
Last Recertification Date
1/29/2019
Entity Termination Date
1/1/2020
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
4/2/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
LLOYD H. BUCKNER, EXECUTIVE DIRECTOR
(202) 638-0750
Contract Pharmacy Representative
Briova Rx
Joe Iovino, Manager
(412) 445-4495
Signed By Date
4/2/2018
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