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OPTUM PHARMACY 701, LLC
CHC26511-09 UPPER GREAT LAKES FAMILY HEALTH CENTER
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Covered Entity Details
Entity Name
UPPER GREAT LAKES FAMILY HEALTH CENTER
Subdivision Name
Calumet Family Health Center- Calumet Ave
Type
HRSA-Funded Health Center
340B ID
CHC26511-09
Entity Address
56720 Calumet Ave.
Calumet, MI 49913
Grant Number
H80CS26511
Participating Start Date
1/1/2017
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 701, LLC
Pharmacy Address
1830 S HORNE
MESA, AZ 85204
Pharmacy Comments
Contract Details
Approval Date
10/7/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Donald A. Simila, CEO
(906) 481-8571
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
10/7/2024
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