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OPTUM PHARMACY 701, LLC
RRC230141-00 MCLAREN FLINT
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Covered Entity Details
Entity Name
MCLAREN FLINT
Subdivision Name
Type
Rural Referral Center
340B ID
RRC230141-00
Entity Address
401 S. BALLENGER
FLINT, MI 48532
Medicare Provider Number
230141
Participating Start Date
12/22/2020
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 701, LLC
Pharmacy Address
1830 S HORNE
MESA, AZ 85204
Pharmacy Comments
Contract Details
Approval Date
7/15/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
FRED KORTE, CFO
(248) 338-5691
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
7/15/2024
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