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OPTUM PHARMACY 701, LLC
DSH230070 COVENANT MEDICAL CENTER
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Covered Entity Details
Entity Name
COVENANT MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230070
Entity Address
1447 N HARRISON STREET
SAGINAW, MI 48602
Medicare Provider Number
230070
Participating Start Date
4/1/2004
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 701, LLC
Pharmacy Address
4100 S SAGINAW ST STE D
FLINT, MI 48507
Pharmacy Comments
Contract Details
Approval Date
4/11/2022
Contract Begin Date
4/13/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
KEVIN S. ALBOSTA, CFO
(989) 583-2769
Contract Pharmacy Representative
Avella/BriovaRx
Paul Leschinert, National Account Manager,340B Sales
(847) 409-0200
Signed By Date
4/11/2022
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