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OPTUM PHARMACY 700, LLC
DSH230080 MCLAREN CENTRAL MICHIGAN
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Covered Entity Details
Entity Name
MCLAREN CENTRAL MICHIGAN
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230080
Entity Address
1221 SOUTH DRIVE
MT PLEASANT, MI 48858
Medicare Provider Number
230080
Participating Start Date
10/1/2021
Last Recertification Date
8/26/2024
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
10/15/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tara Soules, Chief Financial Officer
(989) 772-6818
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/15/2021
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