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OPTUM PHARMACY 705, LLC
DSH230030 MyMichigan Medical Center Alma
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Covered Entity Details
Entity Name
MyMichigan Medical Center Alma
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230030
Entity Address
300 EAST WARWICK DRIVE
ALMA, MI 48801
Medicare Provider Number
230030
Participating Start Date
4/1/2018
Last Recertification Date
8/25/2022
Entity Termination Date
10/1/2023
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 705, LLC
Pharmacy Address
1100 LEE BRANCH LN
BIRMINGHAM, AL 35242-7298
Pharmacy Comments
Contract Details
Approval Date
1/17/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Heather R Wager, Director of Finance
(989) 466-3281
Contract Pharmacy Representative
Avella
Nancy McCutcheon, Sr VP of Strategic Sales
(651) 983-0677
Signed By Date
1/17/2023
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