340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
OPTUM PHARMACY 702, LLC
DSH230036 MyMichigan Medical Center Alpena
Print
Covered Entity Details
Entity Name
MyMichigan Medical Center Alpena
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230036
Entity Address
1501 W. CHISHOLM
ALPENA, MI 49707
Medicare Provider Number
230036
Participating Start Date
7/1/2019
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
1/10/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
michael joseph erickson, President
(989) 839-3378
Contract Pharmacy Representative
Avella
Nancy McCutcheon, Sr VP of Strategic Sales
(651) 983-0677
Signed By Date
1/10/2023
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