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OPTUM INFUSION SERVICES 500, INC.
DSH230230 EDWARD W SPARROW HOSPITAL ASSOCIATION
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Covered Entity Details
Entity Name
EDWARD W SPARROW HOSPITAL ASSOCIATION
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230230
Entity Address
1215 E MICHIGAN AVE
LANSING, MI 48912
Medicare Provider Number
230230
Participating Start Date
10/1/2004
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
OPTUM INFUSION SERVICES 500, INC.
Pharmacy Address
19 CHAPIN RD BLDG D
SUITE D7
PINE BROOK, NJ 07058-9385
Pharmacy Comments
Contract Details
Approval Date
1/19/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/2/2022
Agreement registered in error
Contacts
Covered Entity Signing Official
William Howe, SHS-VP Chief Financial Officer Sparrow Hospital
(517) 253-6102
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
1/19/2022
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