340B Drug Pricing Program Database
OPTUM PHARMACY 702, LLC
CAH231340-00 HURON MEMORIAL HOSPITAL - information as of 5/9/2025 11:18:34 PM
Covered Entity Details
Entity Name
HURON MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH231340-00
Entity Address
1100 SOUTH VAN DYKE
BAD AXE, MI 48413
Medicare Provider Number
231340
Participating Start Date
4/8/2021
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
4/18/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Danielle Christine Jacks-Porter, Chief Financial Officer
(989) 894-3838
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/18/2022
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