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OPTUM PHARMACY 701, LLC
DSH230236 METROPOLITAN HOSPITAL
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Covered Entity Details
Entity Name
METROPOLITAN HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230236
Entity Address
5900 BYRON CENTER AVE SW
WYOMING, MI 49519
Medicare Provider Number
230236
Participating Start Date
7/1/2004
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 701, LLC
Pharmacy Address
1830 S HORNE
MESA, AZ 85204
Pharmacy Comments
Contract Details
Approval Date
1/6/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Dana Habers, Chief Operating Officer, Pharmacy
(734) 936-4338
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
1/6/2025
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