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OPTUM PHARMACY 701, LLC
CH052200 DOWNRIVER COMMUNITY SERVICES INC
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Covered Entity Details
Entity Name
DOWNRIVER COMMUNITY SERVICES INC
Subdivision Name
DOWNRIVER COMMUNITY SERVICES, INC.
Type
HRSA-Funded Health Center
340B ID
CH052200
Entity Address
555 St Clair River Dr
Algonac, MI 48001-1802
Grant Number
H80CS00497
Participating Start Date
10/1/2001
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 701, LLC
Pharmacy Address
1830 S HORNE
MESA, AZ 85204
Pharmacy Comments
Contract Details
Approval Date
10/15/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mike Baranowski, CEO
(586) 270-8055
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
10/15/2024
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