Covered Entity Details

CH051682A2 M.G.H. FAMILY HEALTH CENTER (Terminated) - information as of 6/26/2025 3:09:04 AM

Main Details

Name

M.G.H. FAMILY HEALTH CENTER

Subdivision Name

MUSKEGON FAMILY CARE DENTAL SVS

Type

HRSA-Funded Health Center

Site ID

BPS-H80-005164

340B ID

CH051682A2

Grant Number

H80CS00865

Additional Details

Current Program Status

Terminated

Registration Date

9/30/2005

Participating Start Date

9/30/2005

Participating Approval Date

9/30/2005

Last Recertification Date

2/2/2017

Termination Date
Termination Reason

4/1/2018
Site closure

Contacts

Authorizing Official

MGH Family Health Center
Sheila Bridges, CHIEF EXECUTIVE OFFICER
(231) 737-1751

Primary Contact

M.G.H Family Health Center
Paul L. Schultz, Pharm D
(231) 737-1706

Addresses

Street Address

1700 OAK AVE STE 010
MUSKEGON, MI 49442

Billing Address
Same as Street Address

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

Comments

Comment	Last Updated On
5/5/06 - ADDED MEDICAID # FOR MGH INHOUSE PHARMACY	05/05/2006

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	2367349
		1891898847

Shipping Addresses

Same as Street Address

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	MUSKEGON FAMILY CARE PHARMACY	2201 S GETTY STREET		MUSKEGON HEIGHTS	MI	49444	05/04/2006	05/04/2006		04/01/2018	04/01/2018

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	Address Cont.	City	State
CH0516820	Active	BPS-H80-005220	M.G.H. FAMILY HEALTH CENTER	MUSKEGON FAMILY CARE	2201 S Getty St		Muskegon	MI
CH051682A2	Terminated	BPS-H80-005164	M.G.H. FAMILY HEALTH CENTER	MUSKEGON FAMILY CARE DENTAL SVS	1700 OAK AVE STE 010		MUSKEGON	MI

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH0516820	BENSON DRUG COMPANY, INC	961 SPRING ST		MUSKEGON	MI	49442-3278	07/01/2020
CH0516820	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	10/01/2023
CH0516820	MEIJER DISTRIBUTION INC #90	2721 WALKER AVE NW		GRAND RAPIDS	MI	49544	07/01/2020
CH0516820	MEIJER INC #19	700 WEST NORTON AVENUE		MUSKEGON	MI	49441	07/01/2020
CH0516820	MEIJER INC #232	5300 S HARVEY ST		MUSKEGON	MI	49444-9767	07/01/2020
CH0516820	MEIJER INC #71	1800 HOLTON ROAD		NORTH MUSKEGON	MI	49445	07/01/2020
CH0516820	MEIJER PHARMACY #464	41255 COCA COLA DR.		BELLEVILLE	MI	48111-1827	07/01/2020
CH0516820	MEIJER STORES LIMITED PARTNERSHIP	D/B/A MEIJER PHARMACY #463	1515 PROFIT DR.	FORT WAYNE	IN	46808	07/01/2020
CH0516820	MUSKEGON FAMILY CARE PHARMACY	2201 S GETTY STREET		MUSKEGON HEIGHTS	MI	49444	10/05/2005	09/25/2017
CH051682A2	MUSKEGON FAMILY CARE PHARMACY	2201 S GETTY STREET		MUSKEGON HEIGHTS	MI	49444	05/04/2006	04/01/2018
CH0516820	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	07/01/2020
CH0516820	WAL-MART PHARMACY 10-2238	1879 E SHERMAN BLVD		MUSKEGON	MI	49444	07/01/2020
CH0516820	WAL-MART PHARMACY 10-3876	3285 HENRY STREET		MUSKEGON	MI	49441	07/01/2020
CH0516820	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	07/01/2020
CH0516820	WALGREEN CO	DBA: WALGREENS #12533	819 W MAIN STREET	FREMONT	MI	49412	07/01/2020
CH0516820	WALGREEN CO	DBA: WALGREENS #11417	3284 COLBY RD	WHITEHALL	MI	49461-9637	07/01/2020
CH0516820	WALGREEN CO.	DBA: WALGREENS # 06279	1991 E APPLE AVE	MUSKEGON	MI	49442	07/01/2020
CH0516820	WALGREEN CO.	DBA: WALGREENS # 05315	840 W. SHERMAN BLVD.	MUSKEGON	MI	49441	07/01/2020
CH0516820	WALGREEN CO.	DBA: WALGREENS # 07461	1771 HOLTON ROAD	MUSKEGON	MI	49445-1452	07/01/2020
CH0516820	WALGREEN CO.	DBA: WALGREENS # 10079	1171 E SHERMAN BLVD	NORTON SHORES	MI	49444-1809	07/01/2020
CH0516820	WALGREEN CO.	DBA: WALGREENS # 04835	1000 S. GETTY ST.	MUSKEGON	MI	49442	07/01/2020
CH0516820	WALGREEN CO.	DBA: WALGREENS # 03349	510 N. BEACON BLVD.	GRAND HAVEN	MI	49417	07/01/2020
CH0516820	Walgreens #21423	Walgreens Central Fill #21423	6275 Winchester Blvd	Canal WInchester	OH	43110-6537	01/01/2024
CH0516820	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	10/01/2023
CH0516820	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	10/01/2023
CH0516820	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	10/01/2023
CH0516820	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	01/01/2024
CH0516820	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024
CH0516820	WATKINS PHARMACY & SURGICAL SUPPLY	1391 E SHERMAN BLVD		MUSKEGON	MI	49444	07/01/2020	12/01/2023

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	4/1/2018 12:00 AM
Dates	Last Date That 340B Drugs Purchased	Update	Recertification		11/23/2009 12:00:00 AM	2/14/2018 1:44 PM
Details	State	Update	Recertification	Active	To Be Terminated	2/14/2018 1:44 PM
Terminations	Termination Date	Update	Recertification		4/1/2018 12:00:00 AM	2/14/2018 1:44 PM
Terminations	Termination Effective Date	Update	Recertification		11/23/2009 12:00:00 AM	2/14/2018 1:44 PM
Terminations	Termination Reason	Update	Recertification		Site closure	2/14/2018 1:44 PM
Contacts	Authorizing Official	Update		Bridges, Sheila CHIEF EXECUTIVE OFFICER 2317371751	Bridges, Sheila CHIEF EXECUTIVE OFFICER MGH Family Health Center 2317371751	10/2/2017 9:35 AM
Contacts	Primary Contact	Update	Profile Change Request	Schultz, Paul D. Pharm D M.G.H Family Health Center 2317371744	Schultz, Paul L. Pharm D M.G.H Family Health Center 2317371706	9/25/2017 10:13 AM
Contacts	Primary Contact	Update		Schultz, Paul D. Pharm D 2317371744	Schultz, Paul D. Pharm D M.G.H Family Health Center 2317371744	9/25/2017 9:57 AM
Addresses	Main Address	Insert			1700 OAK AVE STE 010 MUSKEGON, MI 49442	2/2/2017 10:26 AM
Contacts	Primary Contact	Insert			Schultz, Paul D. Pharm D 2317371744	2/2/2017 10:26 AM
Contacts	Authorizing Official	Insert			Bridges, Sheila CHIEF EXECUTIVE OFFICER 2317371751	2/2/2017 10:26 AM
Details	Last Recertification Date	Update		2/15/2016 12:00:00 AM	2/2/2017 12:00:00 AM	2/2/2017 10:26 AM
Medicaid Billing	Medicaid: Is Primary	Update		True	False	2/15/2016 9:21 AM
Details	Last Recertification Date	Update		2/12/2015 12:00:00 AM	2/15/2016 12:00:00 AM	2/15/2016 9:21 AM
Details	Last Recertification Date	Update		3/17/2014 12:00:00 AM	2/12/2015 12:00:00 AM	2/12/2015 10:17 AM
Details	Last Recertification Date	Update		4/1/2013 12:00:00 AM	3/17/2014 12:00:00 AM	3/17/2014 5:21 AM
Details	Entity Name	Update		MGH FAMILY HEALTH CENTER DBA MUSKEGON FAMILY CARE	M.G.H. FAMILY HEALTH CENTER	3/17/2014 5:21 AM
Details	Entity Subname	Update		DENTAL SERVICES	MUSKEGON FAMILY CARE DENTAL SVS	3/17/2014 5:21 AM
Medicaid Billing	NPI: Number	Insert			1891898847	2/14/2013 10:44 AM
Details	Last Recertification Date	Update			4/1/2013 12:00:00 AM	2/14/2013 10:44 AM
Details	Last Recertification Date	Insert				5/5/2006 6:04 AM
Details	Grant Number	Insert			H80CS00865	5/5/2006 6:04 AM
Details	340B ID	Insert			CH051682A2	5/5/2006 6:04 AM
Details	Is Authorizing Official EHB Data	Insert				5/5/2006 6:04 AM
Dates	Last Date That 340B Drugs Purchased	Insert				5/5/2006 6:04 AM
Details	Medicare Provider Number	Insert				5/5/2006 6:04 AM
Details	Entity Name	Insert			MGH FAMILY HEALTH CENTER DBA MUSKEGON FAMILY CARE	5/5/2006 6:04 AM
Details	Program Code	Insert			CH	5/5/2006 6:04 AM
Details	Entity Subname	Insert			DENTAL SERVICES	5/5/2006 6:04 AM
Dates	Participating Approval Date	Insert			9/30/2005 12:00:00 AM	5/5/2006 6:04 AM
Details	State	Insert			Active	5/5/2006 6:04 AM
Dates	Registration Date	Insert			9/30/2005 12:00:00 AM	5/5/2006 6:04 AM
Dates	Signed By Date	Insert			9/29/2005 12:00:00 AM	5/5/2006 6:04 AM
Dates	Start Date	Insert			9/30/2005 12:00:00 AM	5/5/2006 6:04 AM
Terminations	Termination Comments	Insert				5/5/2006 6:04 AM
Terminations	Termination Date	Insert				5/5/2006 6:04 AM
Terminations	Termination Effective Date	Insert				5/5/2006 6:04 AM
Terminations	Termination Reason	Insert				5/5/2006 6:04 AM
Details	Comments Public	Insert			5/5/06 - ADDED MEDICAID # FOR MGH INHOUSE PHARMACY	5/5/2006 6:04 AM
Medicaid Billing	Medicaid: Is Primary	Insert			True	9/30/2005 11:49 AM
Medicaid Billing	Medicaid: Number	Insert			2367349	9/30/2005 11:49 AM
Medicaid Billing	Medicaid: State	Insert			MI	9/30/2005 11:49 AM

340B Drug Pricing Program Database

Comments

Medicaid Billing

Shipping Addresses

Contract Pharmacies

Grantee Sites

Grantee Sites Contract Pharmacies

History