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OPTUM PHARMACY 700, LLC
CAH231322-00 MUNSON HEALTHCARE CHARLEVOIX HOSPITAL
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Covered Entity Details
Entity Name
MUNSON HEALTHCARE CHARLEVOIX HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH231322-00
Entity Address
14700 LAKE SHORE DRIVE
CHARLEVOIX, MI 49720-1931
Medicare Provider Number
231322
Participating Start Date
10/1/2012
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
4/5/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kathleen M LaRaia, Vice President
(231) 392-8410
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/5/2024
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