340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
OPTUM PHARMACY 702, LLC
SCH230222-00 MYMICHIGAN MEDICAL CENTER MIDLAND
Print
Covered Entity Details
Entity Name
MYMICHIGAN MEDICAL CENTER MIDLAND
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH230222-00
Entity Address
4000 WELLNESS DRIVE
MIDLAND, MI 48670
Medicare Provider Number
230222
Participating Start Date
7/1/2020
Last Recertification Date
8/19/2024
Entity Termination Date
1/1/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
10/15/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Bryan Rex Cross, President
(989) 839-1322
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/15/2021
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