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OPTUM PHARMACY 700, LLC
DSH230236 METROPOLITAN HOSPITAL
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Covered Entity Details
Entity Name
METROPOLITAN HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230236
Entity Address
5900 BYRON CENTER AVE SW
WYOMING, MI 49519
Medicare Provider Number
230236
Participating Start Date
7/1/2004
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 700, LLC
Pharmacy Address
5700 DOT COM CT, STE 1000
OVIEDO, FL 32765
Pharmacy Comments
Contract Details
Approval Date
10/11/2021
Contract Begin Date
10/21/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kris Kurtz, CFO
(616) 252-4844
Contract Pharmacy Representative
Briova Rx
Joe Iovino, Manager
(412) 445-4495
Signed By Date
10/11/2021
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