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OPTUM PHARMACY 705, LLC
DSH230046 UNIVERSITY OF MICHIGAN HOSPITALS AND HEALTH CENTERS
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Covered Entity Details
Entity Name
UNIVERSITY OF MICHIGAN HOSPITALS AND HEALTH CENTERS
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230046
Entity Address
1500 EAST MEDICAL CENTER DRIVE
ANN ARBOR, MI 48109
Medicare Provider Number
230046
Participating Start Date
1/1/2004
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 705, LLC
Pharmacy Address
1893 GENERAL GEORGE PATTON DR
STE 106
FRANKLIN, TN 37067-2655
Pharmacy Comments
Contract Details
Approval Date
4/4/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
David Miller, President University of Michigan Health Systems
(734) 647-6313
Contract Pharmacy Representative
Avella/BriovaRx
Paul Leschinert, National Account Manager,340B Sales
(847) 409-0200
Signed By Date
4/4/2022
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