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OPTUM PHARMACY 702, LLC
DSH230270 OAKWOOD HEALTHCARE INC. dba Corewell Health Taylor Hospital
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Covered Entity Details
Entity Name
OAKWOOD HEALTHCARE INC. dba Corewell Health Taylor Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230270
Entity Address
10000 Telegraph Road
TAYLOR, MI 48180
Medicare Provider Number
230270
Participating Start Date
10/1/2015
Last Recertification Date
8/27/2024
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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