Covered Entity Details

DSH230207 McLaren Oakland (Active) - information as of 4/28/2025 11:26:01 PM

Main Details

Name

McLaren Oakland

Subdivision Name

Type

Disproportionate Share Hospital

Rural

340B ID

DSH230207

Medicare Provider Number

230207

Additional Details

Current Program Status

Active

Registration Date

11/26/2007

Participating Start Date

1/1/2005

Participating Approval Date

11/26/2007

Last Recertification Date

8/26/2024

Contacts

Authorizing Official

McLaren Oakland
Lynn Marcotte, CFO
(248) 338-5691

Primary Contact

McLaren Health Care
Tiffany Harwood, Corporate Director of 340B Data Analytics
(734) 512-8778

Addresses

Street Address

50 NORTH PERRY
PONTIAC, MI 48342

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
2/23/12 remove sub entity name as it was a pharmacy 5/9/08 ADDED SUBDIV. NAME; 5/9/08 ADDED MEDICAID #.06/01/2011 ADDED SHIP TO ADDR.	02/23/2012
5/9/08 ADDED SUBDIV. NAME; 5/9/08 ADDED MEDICAID #.06/01/2011 ADDED SHIP TO ADDR.	06/01/2011

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		1376564088

Shipping Addresses

Shipping Address 1

MCLAREN Oakland
50 North Perry
Pontiac, MI 48342

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	07/15/2016	10/01/2016	10/25/2021	10/31/2021
Contract Detail	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	07/15/2016	10/01/2016	07/01/2021	07/01/2021
Contract Detail	ACCREDO HEALTH GROUP INC	39625 LEWIS DR	STE 800	NOVI	MI	48377-2962	07/15/2016	10/01/2016	07/01/2021	07/01/2021
Contract Detail	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	01/16/2024	04/01/2024		04/01/2024
Contract Detail	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	07/15/2016	10/01/2016	06/30/2023	10/01/2023
Contract Detail	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	07/15/2016	10/01/2016	07/01/2021	07/01/2021
Contract Detail	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	04/29/2022	07/01/2022		07/01/2022
Contract Detail	APEX DRUG STORES, INC.	RITE AID #4592	5789 ORTONVILLE ROAD	CLARKSTON	MI	48346	01/13/2014	04/01/2014	10/01/2020	07/17/2021
Contract Detail	APEX DRUG STORES, INC.	RITE AID #4515	BLOOMFIELD SQUARE 3251 SOUTH BOULEVARD	AUBURN HILLS	MI	48326	01/13/2014	04/01/2014	10/01/2020	07/17/2021
Contract Detail	BARBARA ANN KARMANOS CANCER HOSPITAL	DBA KARMANOS SPECIALTY PHARMACY	711 STEPHENSON HWY	TROY	MI	48083-1128	04/18/2019	07/01/2019		07/01/2019
Contract Detail	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	10/18/2016	01/01/2017	01/13/2017	05/11/2017
Contract Detail	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	10/18/2016	01/01/2017	01/01/2019	11/11/2020
Contract Detail	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	10/18/2016	01/01/2017	01/13/2017	05/11/2017
Contract Detail	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	10/18/2016	01/01/2017	01/13/2017	05/11/2017
Contract Detail	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	10/18/2016	01/01/2017	01/01/2019	11/11/2020
Contract Detail	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	10/18/2016	01/01/2017	01/13/2017	05/11/2017
Contract Detail	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	10/18/2016	01/01/2017	01/13/2017	05/11/2017
Contract Detail	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	10/18/2016	01/01/2017	01/13/2017	05/11/2017
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	10/18/2016	01/01/2017	01/13/2017	05/11/2017
Contract Detail	DIPLOMAT SPECIALTY PHARMACY	4100 S SAGINAW ST	STE D	FLINT	MI	48507-2683	01/14/2014	04/01/2014	01/01/2020	11/11/2020
Contract Detail	DIPLOMAT SPECIALTY PHARMACY	G3320 BEECHER RD		FLINT	MI	48532-3614	01/14/2014	04/01/2014	12/31/2019	03/17/2021
Contract Detail	DIPLOMAT SPECIALTY PHARMACY	4100 S SAGINAW ST	STE D	FLINT	MI	48507-2683	03/17/2021	04/01/2021	07/01/2022	09/13/2022
Contract Detail	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	01/15/2018	04/01/2018	07/11/2018	07/11/2018
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	255 PHILLIPI ROAD	COLUMBUS	OH	43228	01/15/2018	04/01/2018	07/11/2018	07/11/2018
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	01/15/2018	04/01/2018	07/02/2024	07/02/2024
Contract Detail	HENRY FORD PHARMACY ADVANTAGE SOUTHFIELD	1191 SOUTH BLVD. E.		ROCHESTER HILLS	MI	48307	04/18/2019	07/01/2019	05/03/2024	05/03/2024
Contract Detail	KROGER CO OF MI #649	3097 S BALDWIN RD		ORION	MI	48359	04/18/2019	07/01/2019	12/22/2024	12/22/2024
Contract Detail	KROGER CO OF MICHIGAN	KROGER PHARMACY #651	5990 SASHABAW RD	CLARKSTON	MI	48346	07/15/2016	10/01/2016	12/22/2024	12/22/2024
Contract Detail	KROGER CO OF MICHIGAN #675	5111 HIGHLAND RD		WATERFORD	MI	48327	07/15/2016	10/01/2016	05/25/2022	06/13/2022
Contract Detail	KROGER CO OF MICHIGAN #709	9741 DIXIE HIGHWAY		CLARKSTON	MI	48348	07/15/2016	10/01/2016	01/04/2024	01/16/2024
Contract Detail	KROGER PHARMACY #759	10951 HIGHLAND RD		WHITE LAKE	MI	48386	04/18/2019	07/01/2019	10/25/2021	10/31/2021
Contract Detail	MCLAREN DRUG SHOP-MCRMC	1000 HARRINGTON		MOUNT CLEMENS	MI	48043	10/26/2016	01/01/2017	11/30/2018	09/25/2019
Contract Detail	MCLAREN HOME INFUSION	1515 CAL DR		DAVISON	MI	48423-9016	10/29/2022	01/01/2023		01/01/2023
Contract Detail	MEIJER DISTRIBUTION INC #90	2721 WALKER AVE NW		GRAND RAPIDS	MI	49544	01/14/2014	04/01/2014		05/11/2017
Contract Detail	MEIJER INC #177	8401 26 MILE ROAD		WASHINGTON TWP	MI	48094	04/18/2019	07/01/2019	10/25/2021	10/31/2021
Contract Detail	MEIJER INC #185	800 BROWN ROAD		AUBURN HILLS	MI	48326-1309	01/14/2014	04/01/2014		05/11/2017
Contract Detail	MEIJER INC #197	900 N. LAPEER ROAD		OXFORD	MI	48371	01/14/2014	04/01/2014		05/11/2017
Contract Detail	MEIJER INC #243	40445 S. GROESBECK HWY		CLINTON TOWNSHIP	MI	48036	04/18/2019	07/01/2019	10/25/2021	10/31/2021
Contract Detail	MEIJER INC #260	3610 MARKETPLACE CIRCLE		ROCHESTER HILLS	MI	48309	01/14/2014	04/01/2014	06/06/2022	06/06/2022
Contract Detail	MEIJER INC #53	4200 HIGHLAND ROAD		WATERFORD	MI	48328	01/14/2014	04/01/2014	03/04/2024	03/04/2024
Contract Detail	MEIJER INC #57	3175 S. ROCHESTER RD		ROCHESTER HILLS	MI	48307	04/18/2019	07/01/2019	10/25/2021	10/31/2021
Contract Detail	MEIJER PHARMACY #464	41255 COCA COLA DR.		BELLEVILLE	MI	48111-1827	10/07/2016	01/01/2017		05/11/2017
Contract Detail	MEIJER STORES LIMITED PARTNERSHIP	D/B/A MEIJER PHARMACY #463	1515 PROFIT DR.	FORT WAYNE	IN	46808	01/14/2014	04/01/2014		05/11/2017
Contract Detail	MEIJER, INC. #140	1555 DEMILLE RD		LAPEER	MI	48446	01/14/2014	04/01/2014		05/11/2017
Contract Detail	MEIJER, INC. #227	6001 HIGHLAND ROAD		WHITE LAKE	MI	48383-2744	01/14/2014	04/01/2014	03/04/2024	03/04/2024
Contract Detail	NOVIXUS PHARMACY SERVICES		43159 WEST NINE MILE ROAD	NOVI	MI	48376	07/07/2016	10/01/2016	05/01/2017	05/11/2017
Contract Detail	OPTION CARE ENTERPRISES, INC.	D/B/A OPTION CARE	11403 BLUEGRASS PARKWAY SUITE 400	LOUISVILLE	KY	40299-2398	10/18/2016	01/01/2017	07/12/2018	07/12/2018
Contract Detail	OPTION CARE ENTERPRISES, INC.	DBA OPTION CARE	1255 MICHIGAN ST. NE	GRAND RAPIDS	MI	49503	10/18/2016	01/01/2017	07/12/2018	07/12/2018
Contract Detail	OPTION CARE ENTERPRISES, INC.	DBA OPTION CARE	27005 HILLS TECH COURT	FARMINGTON HILLS	MI	48331-5723	10/18/2016	01/01/2017	07/12/2018	07/12/2018
Contract Detail	OPTUM FRONTIER THERAPIES II, LLC	6425 SANTA MARGARITA ST UNIT 110		LAS VEGAS	NV	89118-1913	04/18/2019	07/01/2019	10/25/2021	10/31/2021
Contract Detail	OPTUM INFUSION SERVICES 305, LLC	15529 COLLEGE BLVD.		LENEXA	KS	66219-1351	10/20/2021	01/01/2022	02/05/2024	02/05/2024
Contract Detail	OPTUM PHARMACY 700, LLC	5700 DOT COM CT, STE 1000		OVIEDO	FL	32765	01/16/2024	04/01/2024		04/01/2024
Contract Detail	OPTUM PHARMACY 701, LLC	4100 S SAGINAW ST STE D		FLINT	MI	48507	04/29/2022	05/19/2022		05/19/2022
Contract Detail	OPTUM PHARMACY 701, LLC	1830 S HORNE		MESA	AZ	85204	10/03/2024	01/01/2025		01/01/2025
Contract Detail	OPTUM PHARMACY 701, LLC	4015 SHOPTON RD STE 600		CHARLOTTE	NC	28217-3025	01/15/2025	04/01/2025		04/01/2025
Contract Detail	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	04/18/2019	07/01/2019		07/01/2019
Contract Detail	OPTUM PHARMACY 705, LLC	1100 LEE BRANCH LN		BIRMINGHAM	AL	35242-7298	04/18/2019	07/01/2019	10/25/2021	10/31/2021
Contract Detail	OPTUM PHARMACY 705, LLC	3539 BLUECUTT RD		COLUMBUS	MS	39705	10/20/2021	01/01/2022		01/01/2022
Contract Detail	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	04/18/2019	07/01/2019	02/05/2024	02/05/2024
Contract Detail	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	01/16/2024	04/01/2024		04/01/2024
Contract Detail	PERRY DRUG STORES, INC.	RITE AID #4302	1186 BALDWIN AVENUE	PONTIAC	MI	48340	01/13/2014	04/01/2014	08/02/2024	09/08/2024
Contract Detail	PERRY DRUG STORES, INC.	RITE AID #4301	360 N ML KING JR BLVD	PONTIAC	MI	48342	01/13/2014	04/01/2014	07/18/2024	09/08/2024
Contract Detail	PERRY DRUG STORES, INC.	RITE AID #4325	5983 HIGHLAND ROAD	WATERFORD	MI	48327	01/13/2014	04/01/2014	10/25/2021	10/31/2021
Contract Detail	PERRY DRUG STORES, INC.	RITE AID #4377	42931 WOODWARD AVENUE	BLOOMFIELD HILLS	MI	48304	01/13/2014	04/01/2014	04/01/2020	11/11/2020
Contract Detail	PERRY DRUG STORES, INC.	RITE AID #4304	3273 WEST HURON STREET	WATERFORD	MI	48328	01/13/2014	04/01/2014	04/01/2020	11/11/2020
Contract Detail	PERRY DRUG STORES, INC.	RITE AID #4476	4350 DIXIE HIGHWAY	WATERFORD	MI	48329	01/13/2014	04/01/2014	10/25/2021	10/31/2021
Contract Detail	PERRY DRUG STORES, INC.	RITE AID #4338	2480 LAPEER ROAD	AUBURN HILLS	MI	48326	01/13/2014	04/01/2014	10/25/2021	10/31/2021
Contract Detail	PERRY DRUG STORES, INC.	RITE AID #4477	3000 ORCHARD LAKE ROAD	KEEGO HARBOR	MI	48320	04/18/2019	07/01/2019	04/01/2020	11/11/2020
Contract Detail	PERRY DRUG STORES, INC.	RITE AID #4306	2880 EAST HIGHLAND ROAD	HIGHLAND	MI	48356	04/18/2019	07/01/2019	04/01/2020	11/11/2020
Contract Detail	PERRY DRUG STORES, INC.	RITE AID #4309	1022 WEST GENESEE STREET	LAPEER	MI	48446	04/18/2019	07/01/2019	04/01/2020	11/11/2020
Contract Detail	PERRY DRUG STORES, INC.	RITE AID #4319	8360 SOUTH SAGINAW STREET	GRAND BLANC	MI	48439	10/15/2020	01/01/2021	01/01/2024	01/17/2024
Contract Detail	PINE KNOB PHARMACY #1 INC	5701 BOW POINTE DRIVE	SUITE #130	CLARKSTON	MI	48346	07/07/2016	10/01/2016	11/01/2017	07/11/2018
Contract Detail	PINE KNOB PHARMACY #3 INC	6770 DIXIE HWY		CLARKSTON	MI	48346-2087	07/07/2016	10/01/2016	11/01/2017	07/11/2018
Contract Detail	PINE KNOB PHARMACY #6 INC	1701 BALDWIN AVE	SUITE 100	PONTIAC	MI	48340	07/07/2016	10/01/2016	11/01/2017	07/11/2018
Contract Detail	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	10/18/2016	01/01/2017	01/01/2019	11/11/2020
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #11338	10160 INTERNATIONAL BLVD.	WEST CHESTER	OH	45246	10/15/2020	01/01/2021	05/25/2022	05/25/2022
Contract Detail	RITE AID OF MICHIGAN, INC.	RITE AID #4697	3 SOUTH TELEGRAPH ROAD	PONTIAC	MI	48341	01/13/2014	04/01/2014	10/25/2021	10/31/2021
Contract Detail	RITE AID OF MICHIGAN, INC.	RITE AID #3497	15242 NORTH HOLLY ROAD	HOLLY	MI	48442	04/18/2019	07/01/2019	04/01/2020	11/11/2020
Contract Detail	RITE AID OF MICHIGAN, INC.	RITE AID #4696	10 SOUTH ORTONVILLE ROAD	ORTONVILLE	MI	48462	04/18/2019	07/01/2019	08/07/2024	09/08/2024
Contract Detail	RITE AID OF MICHIGAN, INC.	RITE AID #7761	999 SOUTH LAPEER ROAD	OXFORD	MI	48371	04/18/2019	07/01/2019	10/25/2021	10/31/2021
Contract Detail	RITE AID OF MICHIGAN, INC.	RITE AID #3356	3939 SOUTH LAPEER ROAD	METAMORA	MI	48455	04/18/2019	07/01/2019	04/01/2020	11/11/2020
Contract Detail	RITE AID OF MICHIGAN, INC.	RITE AID #7912	5751 CLARKSTON ROAD	CLARKSTON	MI	48348	04/18/2019	07/01/2019	10/25/2021	10/31/2021
Contract Detail	RITE AID OF MICHIGAN, INC.	RITE AID #7761	999 SOUTH LAPEER ROAD	OXFORD	MI	48371	04/09/2024	07/01/2024	08/01/2024	09/08/2024
Contract Detail	SINA DRUG LLC	D/B/A ONCO 360	13410 EASTPOINT CENTRE DR STE 101	LOUISVILLE	KY	40223	10/20/2021	01/01/2022		01/01/2022
Contract Detail	SINA DRUG LLC	DBA ONCO360	1985 MARCUS AVE STE 120	NEW HYDE PARK	NY	11042	10/20/2021	01/01/2022	03/04/2024	03/04/2024
Contract Detail	SUPERX DRUGS CORP	DBA THE KROGER CO OF MI 600	540 S MAIN ST	LAPEER	MI	48446	04/18/2019	07/01/2019	12/22/2024	12/22/2024
Contract Detail	THE KROGER CO	66900 GRATIOT		RICHMOND	MI	48062	10/15/2020	01/01/2021	01/04/2024	01/16/2024
Contract Detail	THE KROGER CO OF MI #620	6625 DIXIE HWY		CLARKSTON	MI	48346	07/15/2016	10/01/2016	01/04/2024	01/16/2024
Contract Detail	THE KROGER CO OF MICHIGAN	KROGER PHARMACY #637	460 N LAPEER RD	LAKE ORION	MI	48362	07/15/2016	10/01/2016	12/22/2024	12/22/2024
Contract Detail	THE KROGER CO OF MICHIGAN #650	4888 N ADAMS RD		OAKLAND	MI	48306	04/18/2019	07/01/2019	10/25/2021	10/31/2021
Contract Detail	THE KROGER CO OF MICHIGAN 464	2105 SOUTH BLVD. W		TROY	MI	48098	10/15/2020	01/01/2021	05/25/2022	06/13/2022
Contract Detail	THE KROGER CO OF MICHIGAN 465	1821 SOUTH CEDAR		IMLAY CITY	MI	48444	10/15/2020	01/01/2021	05/25/2022	06/13/2022
Contract Detail	THE KROGER CO. OF MICHIGAN	2051 18 MILE RD		STERLING HEIGHTS	MI	48314-3703	10/15/2020	01/01/2021	05/25/2022	06/13/2022
Contract Detail	WALGREEN CO	DBA: WALGREENS #09928	20 S TELEGRAPH RD	WATERFORD	MI	48328	04/05/2016	07/01/2016		05/11/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04244	4800 DIXIE HIGHWAY	WATERFORD	MI	48329	01/10/2014	04/01/2014		05/11/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04601	690 MARTIN LUTHER KING JR BLVD N	PONTIAC	MI	48342	01/10/2014	04/01/2014	08/15/2015	05/11/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05171	7110 DIXIE HIGHWAY	CLARKSTON	MI	48346	01/10/2014	04/01/2014		05/11/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05675	450 N PARK BLVD	LAKE ORION	MI	48362	01/10/2014	04/01/2014		05/11/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06459	4400 HIGHLAND ROAD	WATERFORD	MI	48328	01/10/2014	04/01/2014	08/28/2015	05/11/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS #12971	571 S MAIN ST	LAPEER	MI	48446	04/05/2016	07/01/2016		05/11/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 09251	3520 S BALDWIN RD	LAKE ORION	MI	48359-1500	04/05/2016	07/01/2016		05/11/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS #15391	34300 WOODWARD AVENUE	BIRMINGHAM	MI	48009-0919	04/18/2019	07/01/2019	10/25/2021	10/31/2021
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04608	1045 S. GRATIOT AVE.	CLINTON TOWNSHIP	MI	48036	04/18/2019	07/01/2019		07/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06175	34899 GROESBECK HWY	CLINTON TOWNSHIP	MI	48035-3366	04/18/2019	07/01/2019	02/04/2024	02/04/2024
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07888	2985 CROOKS RD	ROCHESTER HILLS	MI	48309-3663	04/18/2019	07/01/2019	05/25/2022	05/25/2022
Contract Detail	WALGREEN CO.	DBA: WALGREENS #10953	901 S STATE RD	DAVISON	MI	48423-1721	04/18/2019	07/01/2019		07/01/2019
Contract Detail	Walgreens #21423	Walgreens Central Fill #21423	6275 Winchester Blvd	Canal WInchester	OH	43110-6537	10/20/2023	01/01/2024		01/01/2024
Contract Detail	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	01/10/2014	04/01/2014	07/22/2015	05/11/2017
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	10/18/2016	01/01/2017		05/11/2017
Contract Detail	WOODWARD DETROIT CVS, L.L.C.	DBA: CVS/PHARMACY # 08086	66 E. WALTON BLVD	PONTIAC	MI	48340	01/10/2014	04/01/2014	09/27/2022	09/27/2022
Contract Detail	WOODWARD DETROIT CVS, L.L.C.	DBA: CVS/PHARMACY # 08129	295 S. BROADWAY	LAKE ORION	MI	48362	01/10/2014	04/01/2014	11/16/2024	12/21/2024
Contract Detail	WOODWARD DETROIT CVS, L.L.C.	DBA: CVS/PHARMACY # 08049	4995 HIGHLAND RD.	WATERFORD	MI	48328	01/17/2017	04/01/2017	11/16/2024	12/21/2024
Contract Detail	WOODWARD DETROIT CVS, L.L.C.	DBA: CVS/PHARMACY # 08155	5529 SASHABAW RD.	CLARKSTON	MI	48346	01/17/2017	04/01/2017	11/16/2024	12/21/2024
Contract Detail	WOODWARD DETROIT CVS, L.L.C.	DBA: CVS/PHARMACY # 08062	28774 GRATIOT	ROSEVILLE	MI	48066	10/15/2020	01/01/2021	05/25/2022	05/25/2022
Contract Detail	WOODWARD DETROIT CVS, L.L.C.	DBA: CVS/PHARMACY # 08240	1325 E COMMERCE RD	COMMERCE TOWNSHIP	MI	48382	10/15/2020	01/01/2021	05/25/2022	05/25/2022
Contract Detail	WOODWARD DETROIT CVS, L.L.C.	DBA: CVS/PHARMACY # 08299	10501 HIGHLAND RD.	WHITE LAKE	MI	48386	10/15/2020	01/01/2021	11/16/2024	12/21/2024
Contract Detail	WOODWARD DETROIT CVS, L.L.C.	DBA: CVS/PHARMACY # 08038	7960 COOLEY LAKE RD.	WATERFORD	MI	48327	10/15/2020	01/01/2021	05/25/2022	05/25/2022
Contract Detail	WOODWARD DETROIT CVS, LLC	DBA: CVS/PHARMACY # 08166	1156 W. HURON	WATERFORD	MI	48328	10/15/2020	01/01/2021	08/31/2023	09/06/2023

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH230207A	Child	DSH	McLaren Oakland	Mclaren Oakland - Clarkston Oncology	5680 Bow Pointe Drive	Clarkston	MI	Active
DSH230207AA	Child	DSH	McLaren Oakland	McLaren Oakland Baldwin Family Medicine (Residency Clinic)	1701 Baldwin Avenue	Pontiac	MI	Terminated
DSH230207AB	Child	DSH	McLaren Oakland	MCLAREN OAKLAND PHYSICAL THERAPY	5701 BOW POINTE DRIVE	CLARKSTON	MI	Active
DSH230207AC	Child	DSH	McLaren Oakland	MCLAREN WOUND CENTER	50 N Perry St	Pontiac	MI	Terminated
DSH230207AD	Child	DSH	McLaren Oakland	MCLAREN BREAST CENTER	5701 BOW POINTE DRIVE	CLARKSTON	MI	Active
DSH230207AE	Child	DSH	McLaren Oakland	MCLAREN SLEEP DIAGNOSTIC CENTER	5701 BOW POINTE DRIVE	CLARKSTON	MI	Terminated
DSH230207AF	Child	DSH	McLaren Oakland	MCLAREN OAKLAND WATERFORD FAM MED	3901 HIGHLAND ROAD	WATERFORD	MI	Terminated
DSH230207AG	Child	DSH	McLaren Oakland	McLaren Oakland Comprehensive Breast Center Clarkston - Breast Center	5701 Bow Pointe Dr	Clarkston	MI	Active
DSH230207AH	Child	DSH	McLaren Oakland	MCLAREN OAKLAND - Oxford Oncology	385 N LAPEER RD	OXFORD	MI	Active
DSH230207B	Child	DSH	McLaren Oakland	Mclaren Oakland - Macomb Oncology	1080 Harrington Blvd.	Mt. Clemens	MI	Active
DSH230207C	Child	DSH	McLaren Oakland	Mclaren Oakland - Lapeer Oncology	1295 Barry Drive	Lapeer	MI	Active
DSH230207D	Child	DSH	McLaren Oakland	Clarkston ER	5701 Bow Pointe	Clarkston	MI	Active
DSH230207E	Child	DSH	McLaren Oakland	McLaren Oakland - Oxford Medical Center Emergency Department	385 North Lapeer Rd.	Oxford	MI	Active
DSH230207F	Child	DSH	McLaren Oakland	Mclaren Oakland - Back Care and Pain Management	5625 Water Tower Place	Clarkston	MI	Active
DSH230207G	Child	DSH	McLaren Oakland	Mclaren Oakland - Oxford Premier Occupational Health	385 North Lapeer Rd.	Oxford	MI	Terminated
DSH230207H	Child	DSH	McLaren Oakland	Mclaren Oakland - Oxford Family Practice	385 North Lapeer Rd.	Oxford	MI	Active
DSH230207J	Child	DSH	McLaren Oakland	Mclaren Oakland - Oxford Specialty Clinic	385 North Lapeer Rd	Oxford	MI	Terminated
DSH230207L	Child	DSH	McLaren Oakland	McLaren Clarkston Internal Medicine	6507 Town Center Drive	Clarkston	MI	Terminated
DSH230207M	Child	DSH	McLaren Oakland	McLaren Dixie	6815 Dixie Hwy., Ste 1	Clarkston	MI	Terminated
DSH230207N	Child	DSH	McLaren Oakland	McLaren Lake Orion	1240 South Lapeer Road	Lake Orion	MI	Active
DSH230207P	Child	DSH	McLaren Oakland	McLaren Ortonville	180 North Ortonville Road	Ortonville	MI	Active
DSH230207R	Child	DSH	McLaren Oakland	McLaren Puno	4000 Highland Road,	Waterford	MI	Terminated
DSH230207T	Child	DSH	McLaren Oakland	McLaren Baldwin Akers	1701 Baldwin Road, Ste 102	Pontiac	MI	Terminated
DSH230207V	Child	DSH	McLaren Oakland	McLaren Bloomfield Oncology	43097 Woodward Ave.	Bloomfield Hills	MI	Terminated
DSH230207W	Child	DSH	McLaren Oakland	McLaren Oakland - Children's Health Services	673 MARTIN LUTHER KING JR BLVD N	PONTIAC	MI	Terminated
DSH230207X	Child	DSH	McLaren Oakland	McLaren Oakland - Baybrooke	950 UNIVERSITY DR	PONTIAC	MI	Terminated
DSH230207Y	Child	DSH	McLaren Oakland	McLaren Oakland - Drayton Primary Care	4400 DIXIE HIGHWAY	WATERFORD	MI	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	9/6/2023 3:42:43 PM	8/26/2024 12:56:01 PM	8/26/2024 12:56 PM
Contacts	Primary Contact	Update	Change Request	Brown, Sharelle Corporate, 340B Program Director McLaren Health Care 2483968085	Harwood, Tiffany Corporate Director of 340B Data Analytics McLaren Health Care 7345128778	2/26/2024 9:23 AM
Details	Last Recertification Date	Update	Recertification	9/14/2022 12:42:25 PM	9/6/2023 3:42:43 PM	9/6/2023 3:42 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1790055143 (MI)		12/23/2022 11:35 AM
Details	Last Recertification Date	Update	Recertification	9/13/2021 9:06:23 AM	9/14/2022 12:42:25 PM	9/14/2022 12:42 PM
Details	Last Recertification Date	Update	Recertification	9/9/2020 12:40:40 PM	9/13/2021 9:06:23 AM	9/13/2021 9:06 AM
Contacts	Primary Contact	Update	Profile Change Request	Brown, Sharelle Dir of Pharmacy McLaren Oakland 2483385479	Brown, Sharelle Corporate, 340B Program Director McLaren Health Care 2483968085	1/15/2021 11:38 AM
Medicaid Billing	NPI: State	Update	Recertification		MI	9/9/2020 12:40 PM
Medicaid Billing	NPI: State	Update	Recertification		MI	9/9/2020 12:40 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1528143302 ( )		9/9/2020 12:40 PM
Details	Last Recertification Date	Update	Recertification	8/27/2019 12:36:05 PM	9/9/2020 12:40:40 PM	9/9/2020 12:40 PM
Details	Last Recertification Date	Update	Recertification	9/5/2018 12:08:37 PM	8/27/2019 12:36:05 PM	8/27/2019 12:36 PM
Details	Last Recertification Date	Update	Recertification	12/5/2017 7:29:53 PM	9/5/2018 12:08:37 PM	9/5/2018 12:08 PM
Contacts	Authorizing Official	Update	AO Change Request	Dimond, Margaret Ann CEO McLaren Oakland 2483385379	Marcotte, Lynn CFO McLaren Oakland 2483385691	6/28/2018 2:04 PM
Contacts	Authorizing Official	Update	AO Change Request	LeGault, Matthew CFO McLaren Oakland 2483385691	Dimond, Margaret Ann CEO McLaren Oakland 2483385379	3/26/2018 9:02 AM
Details	Last Recertification Date	Update	Recertification	8/16/2016 12:00:00 AM	12/5/2017 7:29:53 PM	12/5/2017 7:29 PM
Contacts	Authorizing Official	Update		LeGault, Matthew CFO 2483385691	LeGault, Matthew CFO McLaren Oakland 2483385691	10/19/2017 2:40 PM
Contacts	Primary Contact	Update		Brown, Sharelle Dir of Pharmacy 2483385479	Brown, Sharelle Dir of Pharmacy McLaren Oakland 2483385479	10/19/2017 2:39 PM
Contacts	Authorizing Official	Update		KORTE, FRED CFO 2483385691	LeGault, Matthew CFO 2483385691	5/22/2017 9:47 AM
Contacts	Primary Contact	Update		Thatcher, Michele DIRECTOR OF PHARMACY 2483385544	Brown, Sharelle Dir of Pharmacy 2483385479	5/22/2017 9:47 AM
Addresses	Main Address	Insert			50 NORTH PERRY PONTIAC, MI 48342	5/11/2017 3:43 PM
Addresses	Shipping Address	Insert			MCLAREN Oakland 50 North Perry Pontiac, MI 48342	5/11/2017 3:43 PM
Details	Last Recertification Date	Update		8/5/2015 12:00:00 AM	8/16/2016 12:00:00 AM	8/16/2016 8:08 AM
Details	Last Recertification Date	Update		8/6/2014 12:00:00 AM	8/5/2015 12:00:00 AM	8/5/2015 9:08 AM
Medicaid Billing	NPI: Number	Insert			1376564088	12/19/2014 4:32 PM
Medicaid Billing	NPI: Number	Insert			1790055143	12/19/2014 4:32 PM
Medicaid Billing	NPI: Number	Insert			1528143302	12/19/2014 4:32 PM
Details	Last Recertification Date	Update		8/28/2013 12:00:00 AM	8/6/2014 12:00:00 AM	8/6/2014 9:12 AM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	8/28/2013 12:00:00 AM	8/28/2013 1:03 PM
Details	Entity Name	Update		POH MEDICAL CENTER	McLaren Oakland	5/30/2012 4:16 PM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	5/16/2012 7:51 AM
Contacts	Primary Contact	Update		COLLINS, GWENESIA DIRECTOR OF PHARMACY 2483385479	Thatcher, Michele DIRECTOR OF PHARMACY 2483385544	2/23/2012 1:21 PM
Details	Entity Subname	Update		ST. JOHN PONTIAC PHARMACY		2/23/2012 1:21 PM
Details	Comments Public	Insert			2/23/12 remove sub entity name as it was a pharmacy 5/9/08 ADDED SUBDIV. NAME; 5/9/08 ADDED MEDICAID #.06/01/2011 ADDED SHIP TO ADDR.	2/23/2012 1:21 PM
Contacts	Authorizing Official	Insert			KORTE, FRED CFO 2483385691	6/1/2011 12:21 PM
Contacts	Primary Contact	Insert			COLLINS, GWENESIA DIRECTOR OF PHARMACY 2483385479	6/1/2011 12:21 PM
Details	Last Recertification Date	Insert				6/1/2011 12:21 PM
Details	Grant Number	Insert				6/1/2011 12:21 PM
Details	340B ID	Insert			DSH230207	6/1/2011 12:21 PM
Details	Is Authorizing Official EHB Data	Insert				6/1/2011 12:21 PM
Dates	Last Date That 340B Drugs Purchased	Insert				6/1/2011 12:21 PM
Details	Medicare Provider Number	Insert			230207	6/1/2011 12:21 PM
Details	Entity Name	Insert			POH MEDICAL CENTER	6/1/2011 12:21 PM
Details	Program Code	Insert			DSH	6/1/2011 12:21 PM
Details	Entity Subname	Insert			ST. JOHN PONTIAC PHARMACY	6/1/2011 12:21 PM
Dates	Participating Approval Date	Insert			11/26/2007 12:00:00 AM	6/1/2011 12:21 PM
Details	State	Insert			Active	6/1/2011 12:21 PM
Dates	Registration Date	Insert			11/26/2007 12:00:00 AM	6/1/2011 12:21 PM
Dates	Signed By Date	Insert				6/1/2011 12:21 PM
Dates	Start Date	Insert			1/1/2005 12:00:00 AM	6/1/2011 12:21 PM
Terminations	Termination Comments	Insert				6/1/2011 12:21 PM
Terminations	Termination Date	Insert				6/1/2011 12:21 PM
Terminations	Termination Effective Date	Insert				6/1/2011 12:21 PM
Terminations	Termination Reason	Insert				6/1/2011 12:21 PM
Details	Comments Public	Insert			5/9/08 ADDED SUBDIV. NAME; 5/9/08 ADDED MEDICAID #.06/01/2011 ADDED SHIP TO ADDR.	6/1/2011 12:21 PM