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OPTUM PHARMACY 702, LLC
DSH230142 Oakwood Healthcare, Inc. d/b/a Corewell Health Wayne Hospital
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Covered Entity Details
Entity Name
Oakwood Healthcare, Inc. d/b/a Corewell Health Wayne Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230142
Entity Address
33155 ANNAPOLIS STREET
WAYNE, MI 48184
Medicare Provider Number
230142
Participating Start Date
7/1/2008
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
4/15/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Carolyn Wilson, Chief Operating Officer
(947) 522-3338
Contract Pharmacy Representative
Avella
Nancy McCutcheon, Senior Vice President, Strategic Services
(651) 983-0677
Signed By Date
4/15/2019
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