340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
OPTUM PHARMACY 701, LLC
DSH230072 HOLLAND HOSPITAL
Print
Covered Entity Details
Entity Name
HOLLAND HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230072
Entity Address
602 MICHIGAN AVENUE
HOLLAND, MI 49423-4999
Medicare Provider Number
230072
Participating Start Date
1/1/2012
Last Recertification Date
9/5/2024
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
Mark Pawlak, President
(616) 392-5141
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
7/15/2024
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session