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OPTUM PHARMACY 701, LLC
DSH360048 UNIV OF TOLEDO MEDL CENTER
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Covered Entity Details
Entity Name
UNIV OF TOLEDO MEDL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360048
Entity Address
3000 ARLINGTON AVENUE
TOLEDO, OH 43614-2589
Medicare Provider Number
360048
Participating Start Date
4/1/2016
Last Recertification Date
8/29/2024
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
4/19/2022
Contract Begin Date
4/20/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Russell Wayne Smith, Senior Hospital Administrator
(419) 383-3788
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/19/2022
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