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OPTUM PHARMACY 702, LLC
CH053300 HAMILTON COMMUNITY HEALTH NETWORK, INC.
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Covered Entity Details
Entity Name
HAMILTON COMMUNITY HEALTH NETWORK, INC.
Subdivision Name
Hamilton Community Health Network, Inc. - New Main
Type
HRSA-Funded Health Center
340B ID
CH053300
Entity Address
2900 N. Saginaw
Flint, MI 48505-4452
Grant Number
H80CS00435
Participating Start Date
1/1/2000
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
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
CLARENCE PIERCE, CEO
(810) 406-4951
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
10/7/2024
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