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OPTUM PHARMACY 700, LLC
SCH230239-00 MyMichigan Medical Center Sault
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Covered Entity Details
Entity Name
MyMichigan Medical Center Sault
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH230239-00
Entity Address
500 OSBORN BOULEVARD
SAULT STE. MARIE, MI 49783
Medicare Provider Number
230239
Participating Start Date
9/1/2010
Last Recertification Date
8/31/2024
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
4/15/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kevin Kalchik, President
(906) 635-4456
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/15/2024
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