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OPTUM PHARMACY 701, LLC
DSH230046 UNIVERSITY OF MICHIGAN HOSPITALS AND HEALTH CENTERS
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Covered Entity Details
Entity Name
UNIVERSITY OF MICHIGAN HOSPITALS AND HEALTH CENTERS
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230046
Entity Address
1500 EAST MEDICAL CENTER DRIVE
ANN ARBOR, MI 48109
Medicare Provider Number
230046
Participating Start Date
1/1/2004
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 701, LLC
Pharmacy Address
4015 SHOPTON RD STE 600
CHARLOTTE, NC 28217-3025
Pharmacy Comments
Contract Details
Approval Date
4/1/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Dana Habers, Chief Operating Officer, Pharmacy
(323) 240-3032
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
4/1/2025
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