Contract Pharmacy Details

OPTUM PHARMACY 801, INC.
CHC29011-03 PACKARD HEALTH, INC.

Covered Entity Details

Entity Name

PACKARD HEALTH, INC.

Subdivision Name

Packard West

Type

HRSA-Funded Health Center

340B ID

CHC29011-03

Entity Address

1915 Pauline Boulevard
Ann Arbor, MI 48103-2827

Grant Number

H80CS29011

Participating Start Date

4/1/2016

Last Recertification Date

2/13/2025

Pharmacy Details

Pharmacy Name

OPTUM PHARMACY 801, INC.

Pharmacy Address

24416 N 19TH AVE
STE. 100
PHOENIX, AZ 85085

Pharmacy Comments

Contract Details

Approval Date

4/15/2024

Contract Begin Date

7/1/2024

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/1/2024
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Todd R Montrief, Controller
(734) 926-4935

Contract Pharmacy Representative

Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677

Signed By Date

4/15/2024

340B Drug Pricing Program Database