340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
OPTUM PHARMACY 801, INC.
DSH230092 W. A. Foote Memorial Hospital dba Henry Ford Health Jackson Hospital
Print
Covered Entity Details
Entity Name
W. A. Foote Memorial Hospital dba Henry Ford Health Jackson Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230092
Entity Address
205 N. East Ave
JACKSON, MI 49201
Medicare Provider Number
230092
Participating Start Date
4/1/2011
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 801, INC.
Pharmacy Address
23620 N 20TH DR STE 12
PHOENIX, AZ 85085-0621
Pharmacy Comments
Contract Details
Approval Date
10/16/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/14/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jim Bongiorno, CFO
(517) 205-4899
Contract Pharmacy Representative
Avella/BriovaRx
Paul Leschinert, National Account Manager,340B Sales
(847) 409-0200
Signed By Date
10/16/2019
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session