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OPTUM PHARMACY 702, LLC
CH051830 INGHAM COUNTY HEALTH DEPARTMENT
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Covered Entity Details
Entity Name
INGHAM COUNTY HEALTH DEPARTMENT
Subdivision Name
CEDAR COMMUNITY HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH051830
Entity Address
5303 S. Cedar St.
LANSING, MI 48911-3800
Grant Number
H80CS00030
Participating Start Date
10/1/2007
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
10/16/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kris Drake, Executive Director/Deputy Health Officer
(517) 887-4361
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
10/16/2024
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