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OPTUM INFUSION SERVICES 201, INC.
CHC26511-00 UPPER GREAT LAKES FAMILY HEALTH CENTER
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Covered Entity Details
Entity Name
UPPER GREAT LAKES FAMILY HEALTH CENTER
Subdivision Name
Houghton Family Health Center
Type
HRSA-Funded Health Center
340B ID
CHC26511-00
Entity Address
600 MACINNES DR
HOUGHTON, MI 49931
Grant Number
H80CS26511
Participating Start Date
4/1/2014
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
OPTUM INFUSION SERVICES 201, INC.
Pharmacy Address
5700 DOT COM CT STE 1030
OVIEDO, FL 32765-3400
Pharmacy Comments
Contract Details
Approval Date
4/15/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/15/2021
Agreement registered in error
Contacts
Covered Entity Signing Official
Donald A. Simila, CEO
(906) 481-8571
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/15/2021
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