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OPTUM PHARMACY 700, LLC
CAH231325-00 MyMichigan Medical Center Gladwin
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Covered Entity Details
Entity Name
MyMichigan Medical Center Gladwin
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH231325-00
Entity Address
515 QUARTER STREET
GLADWIN, MI 48624
Medicare Provider Number
231325
Participating Start Date
8/31/2010
Last Recertification Date
8/16/2024
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
4/9/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ray Stover, Regional President
(989) 246-6203
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/9/2024
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