Covered Entity Details

CH05036BA GREAT LAKES BAY HEALTH CENTERS (Active) - information as of 6/3/2025 12:02:22 PM

Main Details

Name

GREAT LAKES BAY HEALTH CENTERS

Subdivision Name

Great Lakes Bay Health Centers Bay City Central

Type

HRSA-Funded Health Center

Site ID

BPS-H80-038231

340B ID

CH05036BA

Grant Number

H80CS00689

Additional Details

Current Program Status

Active

Registration Date

4/15/2024

Participating Start Date

7/1/2024

Participating Approval Date

6/6/2024

Last Recertification Date

2/27/2025

Contacts

Authorizing Official

Great Lakes Bay Health Centers
Amy Colleen Evans, CFO
(989) 759-6438

Primary Contact

Great Lakes Bay Health Centers
Kelli N Pardee, 340B Program Assistant Director
(989) 921-5840

Addresses

Street Address

1624 Columbus Ave
Bay City, MI 48708-6827

Billing Address

Great Lakes Bay Health Centers
501 Lapeer Ave
Saginaw, MI 48607

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
MI		1164502803,1194341834,1376010223,1760193395,1871684761,1801907654,1093570293

Shipping Addresses

Shipping Address 1

Great Lakes Bay Health Centers Pharmacy Davenport
3023 Davenport Ave
Saginaw, MI 48602

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
Contract Detail	WOODWARD DETROIT CVS, L.L.C.	DBA CVS/PHARMACY # 10626	101 N. EUCLID AVE	BAY CITY	MI	48706	07/15/2024	10/01/2024			10/01/2024

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	Address Cont.	City	State
CH050360	Active	BPS-H80-002279	Great Lakes Bay Health Centers	Great Lakes Bay Health Centers David R. Gamez	501 Lapeer Ave		Saginaw	MI
CH05036A	Active	BPS-H80-015172	Great Lakes Bay Health Centers	Great Lakes Bay Health Centers Imlay City	6800 Newark Rd	Ste 200	Imlay City	MI
CH05036AA	Active	BPS-H80-014148	Great Lakes Bay Health Centers	Great Lakes Bay Health Centers Integrated Care Thumb Area	1375 R Dale Wertz Dr		Bad Axe	MI
CH05036AB	Active	BPS-H80-017388	Great Lakes Bay Health Centers	Great Lakes Bay Health Centers Thumb Area	876 N Van Dyke Rd		Bad Axe	MI
CH05036AC	Active	BPS-H80-013354	Great Lakes Bay Health Centers	Great Lakes Bay Health Centers Integrated Care Shiawassee	1555 Industrial Dr.		Owosso	MI
CH05036AD	Active	BPS-H80-001921	Great Lakes Bay Health Centers	Great Lakes Bay Health Centers Mobile Dental 1	501 Lapeer		Saginaw	MI
CH05036AE	Active	BPS-H80-000870	Great Lakes Bay Health Centers	Great Lakes Bay Health Centers Mobile Dental 2	501 Lapeer		Saginaw	MI
CH05036AF	Active	BPS-H80-006138	Great Lakes Bay Health Centers	Great Lakes Bay Health Centers Mobile Medical	501 Lapeer		Saginaw	MI
CH05036AG	Terminated	BPS-H80-030075	Great Lakes Bay Health Centers	Great Lakes Bay Health Centers Women's Care West Branch	2110 S M 76	Ste 9	West Branch	MI
CH05036AH	Active	BPS-H80-039015	Great Lakes Bay Health Centers	Great Lakes Bay Health Centers Saginaw United High School	1903 N Niagara St		Saginaw	MI
CH05036AJ	Active	BPS-H80-015643	Great Lakes Bay Health Centers	Great Lakes Bay Health Centers Integrated Care Saginaw	500 Hancock St		Saginaw	MI
CH05036AK	Active	BPS-H80-015636	Great Lakes Bay Health Centers	Great Lakes Bay Health Centers Saginaw Arts and Sciences Academy	3115 Mackinaw St		Saginaw	MI
CH05036AL	Active	BPS-H80-035434	Great Lakes Bay Health Centers	Great Lakes Bay Health Centers Old Town	700 Court St		Saginaw	MI
CH05036AM	Active	BPS-H80-018099	Great Lakes Bay Health Centers	Great Lakes Bay Health Centers Mobile Dental 3	501 Lapeer		Saginaw	MI
CH05036AN	Terminated	BPS-H80-018642	GREAT LAKES BAY HEALTH CENTERS	Valley OB-GYN Clinic	926 N Michigan Ave		Saginaw	MI
CH05036AP	Active	BPS-H80-020859	Great Lakes Bay Health Centers	Great Lakes Bay Health Centers Wolverine Vassar #2	955 Commerce Dr		Vassar	MI
CH05036AQ	Active	BPS-H80-016876	Great Lakes Bay Health Centers	Great Lakes Bay Health Centers Warren Avenue	321 N Warren Ave		Saginaw	MI
CH05036AR	Active	BPS-H80-021979	Great Lakes Bay Health Centers	Great Lakes Bay Health Centers Davenport	3023 Davenport Ave		Saginaw	MI
CH05036AS	Active	BPS-H80-027163	Great Lakes Bay Health Centers	Great Lakes Bay Health Centers Washington Elementary	1821 McKinley St Rm 214		Bay City	MI
CH05036AT	Active	BPS-H80-027953	Great Lakes Bay Health Centers	Great Lakes Bay Health Centers Mobile Medical 2	501 Lapeer Ave		Saginaw	MI
CH05036AU	Active	BPS-H80-029716	Great Lakes Bay Health Centers	Great Lakes Bay Health Centers Bay City South	690 S Trumbull St		Bay City	MI
CH05036AV	Active	BPS-H80-031491	Great Lakes Bay Health Centers	Great Lakes Bay Health Centers TRI-CAP	2300 Veterans Memorial Pkwy		Saginaw	MI
CH05036AW	Active	BPS-H80-029687	Great Lakes Bay Health Centers	Great Lakes Bay Health Centers Bridgeport Spaulding High School	4691 Bearcat Blvd Fl 1		Bridgeport	MI
CH05036AX	Active	BPS-H80-029686	Great Lakes Bay Health Centers	Great Lakes Bay Health Centers Thompson Middle School	3021 Court St Fl 2		Saginaw	MI
CH05036AY	Active	BPS-H80-037529	GREAT LAKES BAY HEALTH CENTERS	Great Lakes Bay Health Centers Mobile Dental 4	501 Lapeer		Saginaw	MI
CH05036AZ	Active	BPS-H80-037293	GREAT LAKES BAY HEALTH CENTERS	Great Lakes Bay Health Centers Mobile Medical 3	501 Lapeer Ave		Saginaw	MI
CH05036B	Terminated	BPS-H80-001271	HEALTH DELIVERY, INC.	WADSWORTH DENTAL CENTER	2308 WADSWORTH AVE		SAGINAW	MI
CH05036BA	Active	BPS-H80-038231	GREAT LAKES BAY HEALTH CENTERS	Great Lakes Bay Health Centers Bay City Central	1624 Columbus Ave		Bay City	MI
CH05036BB	Active	BPS-H80-039065	GREAT LAKES BAY HEALTH CENTERS	Great Lake Bay Health Centers Integrated Care Midland	218 Fast Ice Dr		Midland	MI
CH05036C	Active	BPS-H80-004352	Great Lakes Bay Health Centers	Great Lakes Bay Health Centers Janes Street	1522 Janes St		Saginaw	MI
CH05036D	Terminated	BPS-H80-005711	HEALTH DELIVERY, INC.	HDI TUSCOLA SITE	1309 CLEAVER RD		CARO	MI
CH05036H	Active	BPS-H80-000281	Great Lakes Bay Health Centers	Great Lakes Bay Health Centers Women's Care Bay City	3175 Professional Ct		Bay City	MI
CH05036J	Active	BPS-H80-005203	Great Lakes Bay Health Centers	Great Lakes Bay Health Centers Roosevelt S. Ruffin	229 Gallagher St		Saginaw	MI
CH05036L	Active	BPS-H80-003339	Great Lakes Bay Health Centers	Great Lakes Bay Health Centers Bayside	3884 Monitor Rd		Bay City	MI
CH05036N	Terminated	BPS-H80-005679	HEALTH DELIVERY, INC.	HDI MIGRANT CAMP SITE	4800 Esch Rd		Manchester	MI
CH05036O	Active	BPS-H80-021342	Great Lakes Bay Health Centers	Great Lakes Bay Health Centers Belding	318 S Bridge St	Ste B	Belding	MI
CH05036R	Active	BPS-H80-000646	Great Lakes Bay Health Centers	Great Lakes Bay Health Centers Bridgeport	6297 DIXIE HWY		Bridgeport	MI
CH05036W	Terminated	BPS-H80-002759	Great Lakes Bay Health Centers	Great Lakes Bay Health Centers Wolverine Saginaw	2424 N. Outer Dr		Saginaw	MI
CH05036X	Active	BPS-H80-030365	Great Lakes Bay Health Centers	Great Lakes Bay Health Centers Wolverine Vassar	1015 Commerce Dr		Vassar	MI
CH05036Y	Active	BPS-H80-038463	Great Lakes Bay Health Centers	Great Lakes Bay Health Centers St. Vincent	3400 S Washington Rd		Saginaw	MI
CH05036Z	Active	BPS-H80-015773	Great Lakes Bay Health Centers	Great Lakes Bay Health Centers Shiawassee	200 N Caledonia Dr		Owosso	MI

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH050360	AHSSHC	EXPEDIEN RX PHARMACY	5050 WESLEY RD STE 120	APOPKA	FL	32712	10/01/2017	07/01/2024
CH05036C	AMAZON PHARMACY #001	4500 S PLEASANT VALLEY RD STE 201		AUSTIN	TX	78744-2911	04/01/2018	07/01/2024
CH050360	AMAZON PHARMACY #001	4500 S PLEASANT VALLEY RD STE 201		AUSTIN	TX	78744-2911	01/01/2024	07/01/2024
CH050360	AMAZON PHARMACY #001	4500 S PLEASANT VALLEY RD STE 201		AUSTIN	TX	78744-2911	01/01/2025
CH050360	AMAZON PHARMACY #006	3620 PLAINFIELD RD		INDIANAPOLIS	IN	46231-7003	01/01/2025
CH05036C	APEX DRUG STORES, INC.	RITE AID #4508	4598 STATE STREET	SAGINAW	MI	48603	07/01/2020	07/01/2024
CH050360	APEX DRUG STORES, INC.	RITE AID #4508	4598 STATE STREET	SAGINAW	MI	48603	01/01/2024	08/22/2024
CH05036C	AZ PHARMACY, LLC	DBA AMAZON PHARMACY #002	3809 E WATKINS ST	PHOENIX	AZ	85034	04/01/2019	05/24/2023
CH050360	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	01/01/2022
CH050360	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	01/01/2022
CH050360	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	01/01/2022
CH050360	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	01/01/2022
CH050360	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	01/01/2022
CH050360	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	01/01/2022
CH050360	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	01/01/2022
CH050360	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	01/01/2022
CH050360	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	01/01/2022
CH050360	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	01/01/2022
CH050360	CENTRAL PHARMACY-OWOSSO LLC	111 N. WASHINGTON ST		OWOSSO	MI	48867	01/01/2024
CH05036AC	CENTRAL PHARMACY-OWOSSO LLC	111 N. WASHINGTON ST		OWOSSO	MI	48867	01/01/2024
CH050360	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	01/01/2022
CH050360	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	01/01/2022
CH050360	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	01/01/2022
CH050360	CYSTIC FIBROSIS SERVICES	CYSTIC FIBROSIS SERVICES, INC	10530 JOHN W ELLIOTT DR, STE 200	FRISCO	TX	75033	07/01/2015	08/09/2017
CH050360	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	07/01/2017
CH050360	DELIVERCARERX PHARMACY LLC	DELIVERCARERX PHARMACY LLC	1471 E BUSINESS CENTER DR STE 200	MT PROSPECT	IL	60056	10/01/2017	02/04/2020
CH050360	DOWNS PHARMACY	316 S 4TH AVE		SAGINAW	MI	48607-1602	01/01/2024
CH05036AQ	DOWNS PHARMACY	316 S 4TH AVE		SAGINAW	MI	48607-1602	01/01/2024
CH050360	GENOA HEALTHCARE LLC	500 HANCOCK	SUITE #100	SAGINAW	MI	48602	01/01/2024
CH05036AJ	GENOA HEALTHCARE LLC	500 HANCOCK	SUITE #100	SAGINAW	MI	48602	01/01/2024
CH050360	KROGER COLUMBUS CENTRAL FILL #019	2270 RICKENBACKER PKWY W		COLUMBUS	OH	43217	04/01/2025
CH050360	KROGER DBA: KESSEL #424	945 N. EUCLID		BAY CITY	MI	48706	04/01/2022
CH05036L	KROGER DBA: KESSEL #424	945 N. EUCLID		BAY CITY	MI	48706	10/01/2024
CH05036C	M.N. PHARMACY LLC	DBA AMAZON PHARMACY #003	6701 NW 7TH ST., STE. #199	MIAMI	FL	33126	04/01/2018	05/24/2023
CH050360	M.N. PHARMACY LLC	DBA AMAZON PHARMACY #003	6701 NW 7TH ST., STE. #199	MIAMI	FL	33126	01/01/2025
CH05036C	MAPLEWOOD PHARMACY	LAANSA DRUGS LLC	920 N JOHNSON ST	BAY CITY	MI	48708	01/01/2020	01/06/2020
CH050360	MEDPLEX PHARMACY	MEDPLEX PHARMACY LLC	6318 DIXIE HWY	BRIDGEPORT	MI	48722-9566	04/01/2024
CH05036AW	MEDPLEX PHARMACY	MEDPLEX PHARMACY LLC	6318 DIXIE HWY	BRIDGEPORT	MI	48722-9566	10/01/2024
CH050360	MEIJER DISTRIBUTION INC #90	2721 WALKER AVE NW		GRAND RAPIDS	MI	49544	10/01/2017	07/17/2017
CH05036C	MEIJER DISTRIBUTION INC #90	2721 WALKER AVE NW		GRAND RAPIDS	MI	49544	01/01/2018	07/01/2024
CH050360	MEIJER DISTRIBUTION INC #90	2721 WALKER AVE NW		GRAND RAPIDS	MI	49544	01/01/2024
CH050360	MEIJER INC #113	2591 EAST M21		CORUNNA	MI	48817	10/01/2017	07/17/2017
CH05036C	MEIJER INC #113	2591 EAST M21		CORUNNA	MI	48817	01/01/2018	07/01/2024
CH050360	MEIJER INC #113	2591 EAST M21		CORUNNA	MI	48817	01/01/2024
CH05036R	MEIJER INC #113	2591 EAST M21		CORUNNA	MI	48817	10/01/2024
CH050360	MEIJER INC #187	595 N. PINE		BAY CITY	MI	48708	10/01/2017	07/17/2017
CH05036C	MEIJER INC #187	595 N. PINE		BAY CITY	MI	48708	01/01/2018	07/01/2024
CH050360	MEIJER INC #187	595 N. PINE		BAY CITY	MI	48708	01/01/2024
CH05036X	MEIJER INC #187	595 N. PINE		BAY CITY	MI	48708	01/01/2024
CH05036AT	MEIJER INC #187	595 N. PINE		BAY CITY	MI	48708	07/01/2025
CH050360	MEIJER INC #213	9515 BIRCH RUN ROAD		BIRCH RUN	MI	48415-9613	10/01/2017	07/17/2017
CH05036C	MEIJER INC #213	9515 BIRCH RUN ROAD		BIRCH RUN	MI	48415-9613	01/01/2018	07/01/2024
CH050360	MEIJER INC #213	9515 BIRCH RUN ROAD		BIRCH RUN	MI	48415-9613	01/01/2024
CH050360	MEIJER INC #42	8400 GRATIOT ROAD		SAGINAW	MI	48609	10/01/2017	07/17/2017
CH05036C	MEIJER INC #42	8400 GRATIOT ROAD		SAGINAW	MI	48609	01/01/2018	07/01/2024
CH050360	MEIJER INC #42	8400 GRATIOT ROAD		SAGINAW	MI	48609	01/01/2024
CH05036AM	MEIJER INC #42	8400 GRATIOT ROAD		SAGINAW	MI	48609	01/01/2024
CH050360	MEIJER INC #43	3360 TITTABAWASSEE ROAD		SAGINAW	MI	48604	10/01/2017	07/17/2017
CH05036C	MEIJER INC #43	3360 TITTABAWASSEE ROAD		SAGINAW	MI	48604	01/01/2018	07/01/2024
CH050360	MEIJER INC #43	3360 TITTABAWASSEE ROAD		SAGINAW	MI	48604	01/01/2024
CH05036AF	MEIJER INC #43	3360 TITTABAWASSEE ROAD		SAGINAW	MI	48604	01/01/2024
CH050360	MEIJER INC #48	2980 E WILDER ROAD		BAY CITY	MI	48706	10/01/2017	07/17/2017
CH05036C	MEIJER INC #48	2980 E WILDER ROAD		BAY CITY	MI	48706	01/01/2018	07/01/2024
CH050360	MEIJER INC #48	2980 E WILDER ROAD		BAY CITY	MI	48706	01/01/2024
CH05036AS	MEIJER INC #48	2980 E WILDER ROAD		BAY CITY	MI	48706	01/01/2024
CH050360	MEIJER PHARMACY #464	41255 COCA COLA DR.		BELLEVILLE	MI	48111-1827	10/01/2017	07/17/2017
CH05036C	MEIJER PHARMACY #464	41255 COCA COLA DR.		BELLEVILLE	MI	48111-1827	01/01/2018	07/01/2024
CH050360	MEIJER PHARMACY #464	41255 COCA COLA DR.		BELLEVILLE	MI	48111-1827	01/01/2024
CH050360	MEIJER STORES LIMITED PARTNERSHIP	D/B/A MEIJER PHARMACY #463	1515 PROFIT DR.	FORT WAYNE	IN	46808	10/01/2017	07/17/2017
CH05036C	MEIJER STORES LIMITED PARTNERSHIP	D/B/A MEIJER PHARMACY #463	1515 PROFIT DR.	FORT WAYNE	IN	46808	01/01/2018	07/01/2024
CH050360	MEIJER STORES LIMITED PARTNERSHIP	D/B/A MEIJER PHARMACY #463	1515 PROFIT DR.	FORT WAYNE	IN	46808	01/01/2024
CH050360	OPTUM PHARMACY 700, LLC	5700 DOT COM CT, STE 1000		OVIEDO	FL	32765	01/01/2024
CH050360	OPTUM PHARMACY 701, LLC	4100 S SAGINAW ST STE D		FLINT	MI	48507	01/01/2024
CH050360	OPTUM PHARMACY 701, LLC	1830 S HORNE		MESA	AZ	85204	01/01/2025
CH050360	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	01/01/2024
CH050360	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	01/01/2024
CH05036C	PDS-I MICHIGAN, INC.	RITE AID #4564	531 WEST GENESEE AVENUE	SAGINAW	MI	48602	07/01/2020	12/13/2023
CH050360	PDS-I MICHIGAN, INC.	RITE AID #4564	531 WEST GENESEE AVENUE	SAGINAW	MI	48602	01/01/2024	12/13/2023
CH05036AV	PDS-I MICHIGAN, INC.	RITE AID #4564	531 WEST GENESEE AVENUE	SAGINAW	MI	48602	01/01/2024	12/13/2023
CH05036C	PERRY DRUG STORES, INC.	RITE AID #4324	1002 EAST MAIN STREET	OWOSSO	MI	48867	07/01/2020	09/05/2023
CH05036C	PERRY DRUG STORES, INC.	RITE AID #4382	2910 ASHMAN STREET	MIDLAND	MI	48640	07/01/2020	07/01/2024
CH05036C	PERRY DRUG STORES, INC.	RITE AID #4507	309 NORTH MAIN STREET	FRANKENMUTH	MI	48734	07/01/2020	04/04/2024
CH05036C	PERRY DRUG STORES, INC.	RITE AID #4357	3880 WILDER ROAD	BAY CITY	MI	48706	07/01/2020	07/01/2024
CH05036C	PERRY DRUG STORES, INC.	RITE AID #4502	211 E LAKE STREET	TAWAS CITY	MI	48763-9305	07/01/2020	04/04/2024
CH05036C	PERRY DRUG STORES, INC.	RITE AID #4503	501 EAST HOUGHTON AVENUE	WEST BRANCH	MI	48661	07/01/2020	10/15/2021
CH050360	PERRY DRUG STORES, INC.	RITE AID #4330	557 NORTH CEDAR STREET	IMLAY CITY	MI	48444	10/01/2023	08/22/2024
CH050360	PERRY DRUG STORES, INC.	RITE AID #4507	309 NORTH MAIN STREET	FRANKENMUTH	MI	48734	01/01/2024	04/04/2024
CH050360	PERRY DRUG STORES, INC.	RITE AID #4502	211 E LAKE STREET	TAWAS CITY	MI	48763-9305	01/01/2024	04/04/2024
CH050360	PERRY DRUG STORES, INC.	RITE AID #4382	2910 ASHMAN STREET	MIDLAND	MI	48640	01/01/2024	08/22/2024
CH050360	PERRY DRUG STORES, INC.	RITE AID #4357	3880 WILDER ROAD	BAY CITY	MI	48706	01/01/2024	08/22/2024
CH05036AW	PERRY DRUG STORES, INC.	RITE AID #4357	3880 WILDER ROAD	BAY CITY	MI	48706	01/01/2024	08/22/2024
CH05036C	PILLPACK LLC	DBA PILLPACK BY AMAZON PHARMACY	250 COMMERCIAL ST STE 2012	MANCHESTER	NH	03101	04/01/2018	07/01/2024
CH050360	PILLPACK LLC	DBA PILLPACK BY AMAZON PHARMACY	250 COMMERCIAL ST STE 2012	MANCHESTER	NH	03101	01/01/2024	07/01/2024
CH050360	PILLPACK LLC	DBA PILLPACK BY AMAZON PHARMACY	250 COMMERCIAL ST STE 2012	MANCHESTER	NH	03101	01/01/2025
CH050360	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	01/01/2022
CH050360	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY OR CARELONRX SPECIALTY	ONE WATERFRONT PLAZA 500 ALA MOANA BLVD., BLDG 1	HONOLULU	HI	96813	01/01/2022
CH050360	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	01/01/2022
CH050360	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	01/01/2022
CH05036C	RITE AID OF MICHIGAN, INC.	RITE AID #1551	6155 DIXIE HWY PO BOX 100	BRIDGEPORT	MI	48722-9618	07/01/2020	07/01/2024
CH05036C	RITE AID OF MICHIGAN, INC.	RITE AID #3568	806 GRATIOT AVENUE	SAGINAW	MI	48602	07/01/2020	04/27/2023
CH05036C	RITE AID OF MICHIGAN, INC.	RITE AID #4765	681 NORTH MAIN STREET	PERRY	MI	48872	07/01/2020	07/01/2024
CH05036C	RITE AID OF MICHIGAN, INC.	RITE AID #1575	1470 TITTABAWASSEE ROAD	SAGINAW	MI	48604	07/01/2020	07/01/2024
CH05036C	RITE AID OF MICHIGAN, INC.	RITE AID #1587	4519 RICHFIELD ROAD	FLINT	MI	48506	07/01/2020	10/15/2021
CH05036C	RITE AID OF MICHIGAN, INC.	RITE AID #1740	500 LAFAYETTE AVENUE	BAY CITY	MI	48708	07/01/2020	07/01/2024
CH05036C	RITE AID OF MICHIGAN, INC.	RITE AID #1487	3050 BAY ROAD	SAGINAW	MI	48603	07/01/2020	07/01/2024
CH05036C	RITE AID OF MICHIGAN, INC.	RITE AID #1552	5050 GRATIOT ROAD	SAGINAW	MI	48638-6030	07/01/2020	07/01/2024
CH05036C	RITE AID OF MICHIGAN, INC.	RITE AID #1573	1490 WEST CENTER ROAD	ESSEXVILLE	MI	48732	07/01/2020	09/17/2023
CH05036C	RITE AID OF MICHIGAN, INC.	RITE AID #1745	512 GOODRICH STREET	VASSAR	MI	48768	07/01/2020	05/01/2023
CH05036C	RITE AID OF MICHIGAN, INC.	RITE AID #1615	1004 EAST MICHIGAN AVENUE	LANSING	MI	48912	07/01/2020	10/15/2021
CH05036C	RITE AID OF MICHIGAN, INC.	RITE AID #1576	901 WEST MIDLAND STREET	BAY CITY	MI	48706	07/01/2020	11/16/2023
CH05036C	RITE AID OF MICHIGAN, INC.	RITE AID #3588	3403 EAST GENESEE AVENUE	SAGINAW	MI	48601	07/01/2020	07/01/2024
CH050360	RITE AID OF MICHIGAN, INC.	RITE AID #3312	8531 LANSING HIGHWAY	DURAND	MI	48429	10/01/2023	08/22/2024
CH050360	RITE AID OF MICHIGAN, INC.	RITE AID #1487	3050 BAY ROAD	SAGINAW	MI	48603	01/01/2024	08/22/2024
CH050360	RITE AID OF MICHIGAN, INC.	RITE AID #1575	1470 TITTABAWASSEE ROAD	SAGINAW	MI	48604	01/01/2024	08/22/2024
CH050360	RITE AID OF MICHIGAN, INC.	RITE AID #1552	5050 GRATIOT ROAD	SAGINAW	MI	48638-6030	01/01/2024	08/22/2024
CH050360	RITE AID OF MICHIGAN, INC.	RITE AID #1740	500 LAFAYETTE AVENUE	BAY CITY	MI	48708	01/01/2024	08/22/2024
CH050360	RITE AID OF MICHIGAN, INC.	RITE AID #3588	3403 EAST GENESEE AVENUE	SAGINAW	MI	48601	01/01/2024	08/22/2024
CH050360	RITE AID OF MICHIGAN, INC.	RITE AID #1576	901 WEST MIDLAND STREET	BAY CITY	MI	48706	01/01/2024	11/16/2023
CH050360	RITE AID OF MICHIGAN, INC.	RITE AID #1551	6155 DIXIE HWY PO BOX 100	BRIDGEPORT	MI	48722-9618	01/01/2024	08/22/2024
CH050360	RITE AID OF MICHIGAN, INC.	RITE AID #4765	681 NORTH MAIN STREET	PERRY	MI	48872	01/01/2024	08/22/2024
CH05036R	RITE AID OF MICHIGAN, INC.	RITE AID #1551	6155 DIXIE HWY PO BOX 100	BRIDGEPORT	MI	48722-9618	01/01/2024	08/22/2024
CH05036L	RITE AID OF MICHIGAN, INC.	RITE AID #1740	500 LAFAYETTE AVENUE	BAY CITY	MI	48708	01/01/2024	08/22/2024
CH05036J	RITE AID OF MICHIGAN, INC.	RITE AID #3588	3403 EAST GENESEE AVENUE	SAGINAW	MI	48601	01/01/2024	08/22/2024
CH05036AT	RITE AID OF MICHIGAN, INC.	RITE AID #1552	5050 GRATIOT ROAD	SAGINAW	MI	48638-6030	01/01/2024	08/22/2024
CH05036AZ	RITE AID OF MICHIGAN, INC.	RITE AID #1487	3050 BAY ROAD	SAGINAW	MI	48603	07/01/2024	08/22/2024
CH050360	SUPERX DRUG CORPORATION	DBA KROGER CO #635	2910 CENTER AVENUE	ESSEXVILLE	MI	48732	04/01/2022
CH050360	THE KROGER CO OF MICHIGAN 465	1821 SOUTH CEDAR		IMLAY CITY	MI	48444	04/01/2022
CH05036A	THE KROGER CO OF MICHIGAN 465	1821 SOUTH CEDAR		IMLAY CITY	MI	48444	01/01/2024
CH050360	THE KROGER CO OF MICHIGAN 795	1315 EAST MAIN		OWOSSO	MI	48867-9039	04/01/2022
CH050360	THE KROGER PHARMACY 738	4672 STATE STREET		SAGINAW	MI	48603-3805	04/01/2022
CH05036AE	THE KROGER PHARMACY 738	4672 STATE STREET		SAGINAW	MI	48603-3805	01/01/2024
CH050360	VG'S PHARMACY #1932	1341 N. M-52		OWOSSO	MI	48867-1232	01/01/2024	11/01/2024
CH05036C	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	01/01/2018	07/01/2024
CH050360	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	01/01/2024
CH05036C	WAL-MART PHARMACY 10-1592	901 N VAN DYKE		BAD AXE	MI	48413	01/01/2018	07/01/2024
CH050360	WAL-MART PHARMACY 10-1592	901 N VAN DYKE		BAD AXE	MI	48413	01/01/2024
CH05036AA	WAL-MART PHARMACY 10-1592	901 N VAN DYKE		BAD AXE	MI	48413	01/01/2024
CH05036C	WAL-MART PHARMACY 10-1733	1621 EAST M-21		OWOSSO	MI	48867	01/01/2018	07/01/2024
CH050360	WAL-MART PHARMACY 10-1733	1621 EAST M-21		OWOSSO	MI	48867	01/01/2024
CH05036Z	WAL-MART PHARMACY 10-1733	1621 EAST M-21		OWOSSO	MI	48867	01/01/2024
CH05036C	WAL-MART PHARMACY 10-1752	3921 WILDER RD		BAY CITY	MI	48706	01/01/2018	07/01/2024
CH050360	WAL-MART PHARMACY 10-1752	3921 WILDER RD		BAY CITY	MI	48706	01/01/2024
CH05036H	WAL-MART PHARMACY 10-1752	3921 WILDER RD		BAY CITY	MI	48706	01/01/2024
CH05036C	WAL-MART PHARMACY 10-2644	5825 BROCKWAY ROAD		SAGINAW	MI	48638	01/01/2018	07/01/2024
CH050360	WAL-MART PHARMACY 10-2644	5825 BROCKWAY ROAD		SAGINAW	MI	48638	01/01/2024
CH05036AH	WAL-MART PHARMACY 10-2644	5825 BROCKWAY ROAD		SAGINAW	MI	48638	01/01/2024
CH05036C	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	01/01/2018	07/01/2024
CH050360	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	01/01/2024
CH050360	WALGREEN CO	DBA: WALGREENS #11955	1001 E M 21	OWOSSO	MI	48867	01/01/2014
CH050360	WALGREEN CO	DBA: WALGREENS #12042	2901 CENTER AVENUE	ESSEXVILLE	MI	48732	01/01/2014
CH05036O	WALGREEN CO	DBA: WALGREENS #11955	1001 E M 21	OWOSSO	MI	48867	01/01/2024
CH05036Y	WALGREEN CO	DBA: WALGREENS #12042	2901 CENTER AVENUE	ESSEXVILLE	MI	48732	01/01/2024
CH05036BB	WALGREEN CO	DBA: WALGREENS #12042	2901 CENTER AVENUE	ESSEXVILLE	MI	48732	07/01/2025
CH050360	WALGREEN CO.	DBA: WALGREENS # 05097	4989 STATE ST	SAGINAW	MI	48603	01/01/2014
CH050360	WALGREEN CO.	DBA: WALGREENS # 05167	416 S. EUCLID AVE.	BAY CITY	MI	48706	01/01/2014
CH050360	WALGREEN CO.	DBA: WALGREENS # 05371	2990 BAY ROAD	SAGINAW	MI	48603	01/01/2014
CH050360	WALGREEN CO.	WALGREENS #21328	3730 DIXIE HWY	SAGINAW	MI	48601	01/01/2014
CH050360	WALGREEN CO.	DBA: WALGREENS #21378	1841 N MICHIGAN AVE	SAGINAW	MI	48602	01/01/2014
CH050360	WALGREEN CO.	DBA: WALGREENS # 06559	931 S SAGINAW RD	MIDLAND	MI	48640-4602	01/01/2014
CH050360	WALGREEN CO.	DBA: WALGREENS # 09079	1615 N SAGINAW RD	MIDLAND	MI	48640-7237	01/01/2014
CH050360	WALGREEN CO.	DBA: WALGREENS # 09450	830 N VAN DYKE RD	BAD AXE	MI	48413-9016	01/01/2014
CH050360	WALGREEN CO.	WALGREENS #21234	1900 COLUMBUS AVE STE P	BAY CITY	MI	48708-6831	04/01/2020
CH050360	WALGREEN CO.	WALGREENS #21233	181 W HURON AVE	VASSAR	MI	48768-1235	04/01/2020
CH050360	WALGREEN CO.	DBA: WALGREENS # 10406	2480 E HOUGHTON AVE	WEST BRANCH	MI	48661-1150	10/01/2021
CH05036AP	WALGREEN CO.	DBA: WALGREENS # 05167	416 S. EUCLID AVE.	BAY CITY	MI	48706	01/01/2024
CH05036AB	WALGREEN CO.	DBA: WALGREENS # 09450	830 N VAN DYKE RD	BAD AXE	MI	48413-9016	01/01/2024
CH05036AX	WALGREEN CO.	DBA: WALGREENS # 05371	2990 BAY ROAD	SAGINAW	MI	48603	01/01/2024
CH05036AK	WALGREEN CO.	WALGREENS #21328	3730 DIXIE HWY	SAGINAW	MI	48601	01/01/2024
CH05036AD	WALGREEN CO.	DBA: WALGREENS #21378	1841 N MICHIGAN AVE	SAGINAW	MI	48602	01/01/2024
CH05036AV	WALGREEN CO.	WALGREENS #21234	1900 COLUMBUS AVE STE P	BAY CITY	MI	48708-6831	04/01/2024
CH050360	WALGREEN CO.	DBA: WALGREENS #12971	571 S MAIN ST	LAPEER	MI	48446	08/15/2024
CH05036J	WALGREEN CO.	DBA: WALGREENS # 05167	416 S. EUCLID AVE.	BAY CITY	MI	48706	07/01/2025
CH050360	Walgreens #21423	Walgreens Central Fill #21423	6275 Winchester Blvd	Canal WInchester	OH	43110-6537	01/01/2024
CH050360	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	01/01/2014	06/30/2015
CH050360	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	07/01/2015
CH050360	WALGREENS SPECIALTY PHARMACY, LLC	ALLIANCERX WALGREENS PRIME #12314	9775 SW GEMINI DR, STE 1	BEAVERTON	OR	97008	07/01/2015	10/01/2021
CH050360	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	07/01/2015
CH050360	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	07/01/2015
CH050360	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	07/01/2023
CH050360	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024
CH050360	WOODWARD DETROIT CVS, L.L.C.	DBA CVS/PHARMACY #11252	2040 S CEDAR	IMLAY CITY	MI	48444	01/01/2022	10/04/2023
CH050360	WOODWARD DETROIT CVS, L.L.C.	CVS PHARMACY # 16128	2772 TITTABAWASSEE RD	SAGINAW	MI	48604	01/01/2022
CH050360	WOODWARD DETROIT CVS, L.L.C.	DBA CVS/PHARMACY # 10790	111 NORTH MAIN STREET	FRANKENMUTH	MI	48734	01/01/2022
CH050360	WOODWARD DETROIT CVS, L.L.C.	DBA CVS/PHARMACY # 10626	101 N. EUCLID AVE	BAY CITY	MI	48706	01/01/2022
CH050360	WOODWARD DETROIT CVS, L.L.C.	DBA CVS/PHARMACY #11247	225 E STATE ST PO BOX 96	MONTROSE	MI	48457	01/01/2022
CH05036AG	WOODWARD DETROIT CVS, L.L.C.	DBA CVS/PHARMACY # 10626	101 N. EUCLID AVE	BAY CITY	MI	48706	01/01/2024	04/01/2024
CH050360	WOODWARD DETROIT CVS, L.L.C.	DBA CVS/PHARMACY # 10442	1015 S. SAGINAW RD.	MIDLAND	MI	48640	10/01/2024
CH05036BA	WOODWARD DETROIT CVS, L.L.C.	DBA CVS/PHARMACY # 10626	101 N. EUCLID AVE	BAY CITY	MI	48706	10/01/2024
CH05036AZ	WOODWARD DETROIT CVS, L.L.C.	CVS PHARMACY # 16128	2772 TITTABAWASSEE RD	SAGINAW	MI	48604	10/01/2024
CH05036AY	WOODWARD DETROIT CVS, L.L.C.	DBA CVS/PHARMACY #11247	225 E STATE ST PO BOX 96	MONTROSE	MI	48457	10/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification		2/27/2025 7:27:41 PM	2/27/2025 7:27 PM
Details	State	Update		Approved	Active	7/1/2024 12:01 AM
Addresses	Shipping Address	Delete	New Registration	Great Lakes Bay Health Centers Pharmacy Davenport 3023 Davenport Ave Saginaw, MI 48602		6/6/2024 11:56 AM
Addresses	Billing Address	Insert	New Registration		Great Lakes Bay Health Centers 501 Lapeer Ave Saginaw, MI 48607	6/6/2024 11:56 AM
Addresses	Shipping Address	Insert	New Registration		Great Lakes Bay Health Centers Pharmacy Davenport 3023 Davenport Ave Saginaw, MI 48602	6/6/2024 11:56 AM
Contacts	Signed By	Insert	New Registration		Evans, Amy Colleen CFO Great Lakes Bay Health Centers 9897596438	6/6/2024 11:56 AM
Details	340B ID	Update	New Registration		CH05036BA	6/6/2024 11:56 AM
Dates	Participating Approval Date	Update	New Registration		6/6/2024 11:56:40 AM	6/6/2024 11:56 AM
Details	State	Update	New Registration	Pending	Approved	6/6/2024 11:56 AM
Dates	Signed By Date	Update	New Registration		4/15/2024 3:05:27 PM	6/6/2024 11:56 AM
Dates	Start Date	Update	New Registration		7/1/2024 12:00:00 AM	6/6/2024 11:56 AM
Addresses	Billing Address	Insert	New Registration		Great Lakes Bay Health Centers 501 Lapeer Ave Saginaw, MI 48607	4/15/2024 3:05 PM
Addresses	Shipping Address	Insert	New Registration		Great Lakes Bay Health Centers Pharmacy Davenport 3023 Davenport Ave Saginaw, MI 48602	4/15/2024 3:05 PM
Addresses	Main Address	Insert	New Registration		1624 Columbus Ave Bay City, MI 48708-6827	4/15/2024 12:24 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1164502803	4/15/2024 12:24 PM
Medicaid Billing	NPI: State	Insert	New Registration		MI	4/15/2024 12:24 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1194341834	4/15/2024 12:24 PM
Medicaid Billing	NPI: State	Insert	New Registration		MI	4/15/2024 12:24 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1376010223	4/15/2024 12:24 PM
Medicaid Billing	NPI: State	Insert	New Registration		MI	4/15/2024 12:24 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1760193395	4/15/2024 12:24 PM
Medicaid Billing	NPI: State	Insert	New Registration		MI	4/15/2024 12:24 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1871684761	4/15/2024 12:24 PM
Medicaid Billing	NPI: State	Insert	New Registration		MI	4/15/2024 12:24 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1801907654	4/15/2024 12:24 PM
Medicaid Billing	NPI: State	Insert	New Registration		MI	4/15/2024 12:24 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1093570293	4/15/2024 12:24 PM
Medicaid Billing	NPI: State	Insert	New Registration		MI	4/15/2024 12:24 PM
Contacts	Authorizing Official	Insert	New Registration		Evans, Amy Colleen CFO Great Lakes Bay Health Centers 9897596438	4/15/2024 12:24 PM
Contacts	Primary Contact	Insert	New Registration		Pardee, Kelli N 340B Program Assistant Director Great Lakes Bay Health Centers 9899215840	4/15/2024 12:24 PM
Details	Assistance Received From Date	Insert	New Registration			4/15/2024 12:24 PM
Details	Assistance Received To Date	Insert	New Registration			4/15/2024 12:24 PM
Details	Last Recertification Date	Insert	New Registration			4/15/2024 12:24 PM
Details	Grant Number	Insert	New Registration		H80CS00689	4/15/2024 12:24 PM
Details	340B ID	Insert	New Registration			4/15/2024 12:24 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/15/2024 12:24 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/15/2024 12:24 PM
Details	Medicare Provider Number	Insert	New Registration			4/15/2024 12:24 PM
Details	Entity Name	Insert	New Registration		GREAT LAKES BAY HEALTH CENTERS	4/15/2024 12:24 PM
Details	NOFO Number	Insert	New Registration			4/15/2024 12:24 PM
Details	Program Code	Insert	New Registration		CH	4/15/2024 12:24 PM
Details	Entity Subname	Insert	New Registration		Great Lakes Bay Health Centers Bay City Central	4/15/2024 12:24 PM
Dates	Participating Approval Date	Insert	New Registration			4/15/2024 12:24 PM
Details	State	Insert	New Registration		Pending	4/15/2024 12:24 PM
Dates	Registration Date	Insert	New Registration		4/15/2024 12:24:54 PM	4/15/2024 12:24 PM
Dates	Signed By Date	Insert	New Registration			4/15/2024 12:24 PM
Dates	Start Date	Insert	New Registration			4/15/2024 12:24 PM
Terminations	Termination Comments	Insert	New Registration			4/15/2024 12:24 PM
Terminations	Termination Date	Insert	New Registration			4/15/2024 12:24 PM
Terminations	Termination Effective Date	Insert	New Registration			4/15/2024 12:24 PM
Terminations	Termination Reason	Insert	New Registration			4/15/2024 12:24 PM

340B Drug Pricing Program Database