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OPTUM PHARMACY 701, LLC
CH05183P COUNTY OF INGHAM
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Covered Entity Details
Entity Name
COUNTY OF INGHAM
Subdivision Name
Allen Community Health Center
Type
HRSA-Funded Health Center
340B ID
CH05183P
Entity Address
1601 E Kalamazoo St
Lansing, MI 48912-2701
Grant Number
H80CS00030
Participating Start Date
1/1/2023
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 701, LLC
Pharmacy Address
1830 S HORNE
MESA, AZ 85204
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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