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OPTUM PHARMACY 702, LLC
RRC230167-00 MCLAREN GREATER LANSING
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Covered Entity Details
Entity Name
MCLAREN GREATER LANSING
Subdivision Name
Type
Rural Referral Center
340B ID
RRC230167-00
Entity Address
2900 COLLINS RD.
LANSING, MI 48910
Medicare Provider Number
230167
Participating Start Date
1/1/2025
Last Recertification Date
Entity Termination Date
4/1/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
11/4/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Dale Thompson, Chief Financial Officer
(517) 975-7555
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
10/14/2024
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