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OPTUM PHARMACY 702, LLC
DSH230297 Barbara Ann Karmanos Cancer Hospital DBA Karmanos Cancer Center
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Covered Entity Details
Entity Name
Barbara Ann Karmanos Cancer Hospital DBA Karmanos Cancer Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230297
Entity Address
4100 John R St
DETROIT, MI 48201
Medicare Provider Number
230297
Participating Start Date
7/1/2006
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
7/13/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brian Gamble, Chief Financial Officer
(313) 576-8935
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
7/13/2020
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