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OPTUM PHARMACY 700, LLC
CAH231340-00 HURON MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
HURON MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH231340-00
Entity Address
1100 SOUTH VAN DYKE
BAD AXE, MI 48413
Medicare Provider Number
231340
Participating Start Date
4/8/2021
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 700, LLC
Pharmacy Address
5700 DOT COM CT, STE 1000
OVIEDO, FL 32765
Pharmacy Comments
Contract Details
Approval Date
10/18/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Stephanie Ann Remley, Director of Finance
(810) 210-8163
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/18/2023
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