Covered Entity Details

CH05291Z Family Medical Center of Michigan Inc (Active) - information as of 5/2/2025 10:39:36 PM

Main Details

Name

Family Medical Center of Michigan Inc

Subdivision Name

Family Medical Center - Wagar Middle School

Type

HRSA-Funded Health Center

Site ID

BPS-H80-029904

340B ID

CH05291Z

Grant Number

H80CS00390

Additional Details

Current Program Status

Active

Registration Date

7/7/2020

Participating Start Date

10/1/2020

Participating Approval Date

7/29/2020

Last Recertification Date

3/4/2025

Contacts

Authorizing Official

Family Medical Center of Michigan, Inc.
ED LARKINS, CEO
(734) 847-3802 Ext: 1412

Primary Contact

Family Medical Center of Michigan, Inc.
Zach Terrill, Director of Pharmacy
(517) 263-1800 Ext: 1215

Addresses

Street Address

11270 Grafton Rd Rm 215
Carleton, MI 48117-9392

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
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
No

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
No records to display.

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH052910	Active	BPS-H80-005319	FAMILY MEDICAL CENTER OF MICHIGAN INC	FAMILY MEDICAL CENTER OF MI, INC	8765 Lewis Ave	Temperance	MI
CH05291A	Active	BPS-H80-000823	FAMILY MEDICAL CENTER OF MICHIGAN INC	FAMILY MEDICAL CENTER	130 Medical Center Dr	Carleton	MI
CH05291AA	Active	BPS-H80-029979	Family Medical Center of Michigan Inc	Family Medical Center - Ritter Elementary	5650 Carleton Rockwood Rd RM 100	Carleton	MI
CH05291AB	Active	BPS-H80-029684	Family Medical Center of Michigan Inc	Family Medical Center - Bedford Sr High	8285 Jackman Rd Rm 815	Temperance	MI
CH05291AC	Active	BPS-H80-029863	Family Medical Center of Michigan Inc	Family Medical Center - Eyler Elementary	1335 Carleton Rockwood Rd Rm D	Carleton	MI
CH05291AD	Active	BPS-H80-032264	Family Medical Center of Michigan Inc	Family Medical Center - Waterloo Elementary	1933 S Custer Rd Rm 101	Monroe	MI
CH05291AE	Active	BPS-H80-033940	Family Medical Center of Michigan, Inc.	Family Medical Center - Duke Ellington	9860 Park Dr Lowr	Detroit	MI
CH05291AF	Active	BPS-H80-031256	Family Medical Center of Michigan Inc	Family Medical Center - Monroe Middle School	503 Washington St Rm 150	Monroe	MI
CH05291AG	Active	BPS-H80-031266	Family Medical Center of Michigan, Inc.	Family Medical Center - SMCSI	550 E Main St Ste 1001	Hudson	MI
CH05291AH	Active	BPS-H80-030514	Family Medical Center of Michigan, Inc.	Family Medical Center - Durfee Innovations Society	2740 Collingwood St Ste 100	Detroit	MI
CH05291AJ	Active	BPS-H80-031971	Family Medical Center of Michigan Inc	Family Medical Center - Opportunity Center	120 Eastchester St Lowr	Monroe	MI
CH05291AK	Active	BPS-H80-030074	FAMILY MEDICAL CENTER OF MICHIGAN, INC.	Family Medical Center of MI - Madison Schools	3498 Treat Hwy Rm 35	Adrian	MI
CH05291AL	Active	BPS-H80-037875	FAMILY MEDICAL CENTER OF MICHIGAN, INC.	Family Medical Center of Michigan - Roberto Clemente	1551 Beard St	Detroit	MI
CH05291AM	Active	BPS-H80-038816	FAMILY MEDICAL CENTER OF MICHIGAN, INC.	Family Medical Center - Wayne Elementary	10633 Courville St Rm 208	Detroit	MI
CH05291AN	Active	BPS-H80-037876	FAMILY MEDICAL CENTER OF MICHIGAN, INC.	Family Medical Center - Sampson-Webber Leadership Academy	4700 Tireman St Rm 101	Detroit	MI
CH05291AP	Active	BPS-H80-037874	FAMILY MEDICAL CENTER OF MICHIGAN, INC.	Family Medical Center - Mackenzie Elementary-Middle	10147 W Chicago Lowr	Detroit	MI
CH05291AQ	Active	BPS-H80-038631	FAMILY MEDICAL CENTER OF MICHIGAN, INC.	Edison Elementary School	17405 Grand River Ave	Detroit	MI
CH05291AR	Active	BPS-H80-037873	FAMILY MEDICAL CENTER OF MICHIGAN, INC.	Family Medical Center - Pasteur Elementary	19811 Stoepel St Rm 115	Detroit	MI
CH05291AS	Active	BPS-H80-037878	FAMILY MEDICAL CENTER OF MICHIGAN, INC.	Family Medical Center of Michigan - Priest Elementary/Middle School	7840 Wagner St	Detroit	MI
CH05291AT	Active	BPS-H80-038630	FAMILY MEDICAL CENTER OF MICHIGAN, INC.	Burns Elementary School	14350 Terry St	Detroit	MI
CH05291AU	Active	BPS-H80-037872	FAMILY MEDICAL CENTER OF MICHIGAN, INC.	Family Medical Center - Noble Elementary-Middle School	8646 Fullerton St Lowr	Detroit	MI
CH05291AV	Active	BPS-H80-038085	FAMILY MEDICAL CENTER OF MICHIGAN, INC.	Family Medical Center - Detroit Lions Academy	2001 W Warren Ave	Detroit	MI
CH05291AW	Active	BPS-H80-037900	FAMILY MEDICAL CENTER OF MICHIGAN, INC.	Family Medical Center - Pershing High School	18875 Ryan Rd	Detroit	MI
CH05291AX	Active	BPS-H80-037815	Family Medical Center of Michigan, Inc.	Family Medical Center - Barton Elementary	8530 Joy Rd Uppr	Detroit	MI
CH05291AY	Active	BPS-H80-037948	FAMILY MEDICAL CENTER OF MICHIGAN, INC.	Family Medical Center - Bates Academy	19701 Wyoming St Lowr	Detroit	MI
CH05291AZ	Active	BPS-H80-038629	FAMILY MEDICAL CENTER OF MICHIGAN, INC.	Family Medical Center - Thirkell Elementary-Middle School	7724 14th St Rm 105	Detroit	MI
CH05291C	Terminated	BPS-H80-008088	FAMILY MEDICAL CENTER OF MICHIGAN INC	Family Medical Center of Michigan Monroe	905 N Macomb	Monroe	MI
CH05291CA	Active	BPS-H80-037816	FAMILY MEDICAL CENTER OF MICHIGAN, INC.	Family Medical Center - Cass Tech	2501 2nd Ave Fl 2	Detroit	MI
CH05291CB	Active	BPS-H80-038628	FAMILY MEDICAL CENTER OF MICHIGAN, INC.	Family Medical Center - Mason Academy	19955 Fenelon St Fl 1	Detroit	MI
CH05291CC	Approved	BPS-H80-039200	FAMILY MEDICAL CENTER OF MICHIGAN, INC.	Manor Elementary	1731 W Lorain St	Monroe	MI
CH05291CD	Approved	BPS-H80-039201	FAMILY MEDICAL CENTER OF MICHIGAN, INC.	Arborwood North	1135 Riverview Ave	Monroe	MI
CH05291CE	Approved	BPS-H80-039194	FAMILY MEDICAL CENTER OF MICHIGAN, INC.	Monroe Road Elementary	7979 Monroe Rd	Lambertville	MI
CH05291CF	Approved	BPS-H80-039202	FAMILY MEDICAL CENTER OF MICHIGAN, INC.	Custer Elementary Building 2	5001 W Albain Rd	Monroe	MI
CH05291CG	Approved	BPS-H80-039198	FAMILY MEDICAL CENTER OF MICHIGAN, INC.	Drager Head Start	340 E Church St	Adrian	MI
CH05291CH	Approved	BPS-H80-039199	FAMILY MEDICAL CENTER OF MICHIGAN, INC.	Hudson Middle and High School	771 N Maple Grove Ave	Hudson	MI
CH05291CJ	Approved	BPS-H80-039197	FAMILY MEDICAL CENTER OF MICHIGAN, INC.	Family Medical Center - Lincoln Elementary	746 N Maple Grove Ave Rm 14	Hudson	MI
CH05291CK	Approved	BPS-H80-039195	FAMILY MEDICAL CENTER OF MICHIGAN, INC.	Adrian High School	785 Riverside Ave	Adrian	MI
CH05291CL	Approved	BPS-H80-039193	FAMILY MEDICAL CENTER OF MICHIGAN, INC.	Monroe High School	901 Herr Rd	Monroe	MI
CH05291D	Active	BPS-H80-014082	FAMILY MEDICAL CENTER OF MICHIGAN INC	Family Medical Center of MI - Adrian	1200 N Main St	Adrian	MI
CH05291E	Terminated	BPS-H80-008117	FAMILY MEDICAL CENTER OF MICHIGAN INC	Family Medical Center - Monroe Mental Health Authority Site	1001 S Raisinville Rd	Monroe	MI
CH05291G	Terminated	BPS-H80-017487	FAMILY MEDICAL CENTER OF MICHIGAN INC	Family Medical Center of MI - Monroe II	1085 N Macomb ST.	Monroe	MI
CH05291H	Active	BPS-H80-021266	Family Medical Center of Michigan, Inc.	Family Medical Center - Morenci	788 Coomer St Rm 17	Morenci	MI
CH05291J	Active	BPS-H80-018881	Family Medical Center of Michigan, Inc.	Family Medical Center of MI - Southgate	13101 Allen Rd	Southgate	MI
CH05291K	Active	BPS-H80-021262	Family Medical Center of Michigan, Inc.	Family Medical Center - Arborwood School	1008 Riverview Ave Rm 100	Monroe	MI
CH05291L	Active	BPS-H80-021021	Family Medical Center of Michigan, Inc.	Family Medical Center of MI - Madison Schools	3498 Treat Hwy	Adrian	MI
CH05291M	Terminated	BPS-H80-021263	Family Medical Center of Michigan Inc	Family Medical Center - Deerfield School	252 Deerfield Rd, Rm. 31	Deerfield	MI
CH05291N	Active	BPS-H80-021265	Family Medical Center of Michigan Inc	Family Medical Center - Dundee School	420 Ypsilanti St Rm 100B	Dundee	MI
CH05291P	Active	BPS-H80-021264	Family Medical Center of Michigan Inc	Family Medical Center - Airport School	11330 Grafton Rd Rm 112	Carleton	MI
CH05291Q	Terminated	BPS-H80-021343	Family Medical Center of Michigan Inc	Family Medical Center - Britton School	201 College Ave, Rm. 14	Britton	MI
CH05291R	Active	BPS-H80-024603	Family Medical Center of Michigan, Inc.	Family Medical Center - Carstens School	13000 Essex Ave Rm 211	Detroit	MI
CH05291S	Active	BPS-H80-024655	Family Medical Center of Michigan Inc	Family Medical Center - Thurgood Marshall School	15531 Linwood St Rm 102	Detroit	MI
CH05291T	Active	BPS-H80-027162	Family Medical Center of Michigan, Inc.	Family Medical Center - Custer Elementary School	5003 Albain Rd RM 195	Monroe	MI
CH05291U	Active	BPS-H80-027384	Family Medical Center of Michigan Inc	Family Medical Center - Durfee School	2425 Tuxedo St Rm 115	Detroit	MI
CH05291V	Active	BPS-H80-027915	Family Medical Center of Michigan, Inc.	Family Medical Center - Monroe Main	901 N Macomb St	Monroe	MI
CH05291W	Active	BPS-H80-029862	Family Medical Center of Michigan Inc	Family Medical Center - Neidermeier Elementary School	8400 Newport South RM Speech	Carleton	MI
CH05291X	Active	BPS-H80-029978	Family Medical Center of Michigan, Inc.	Family Medical Center - Sterling Elementary	160 Fessner Rd Rm 106	Carleton	MI
CH05291Y	Active	BPS-H80-029685	Family Medical Center of Michigan Inc	Family Medical Center - Bedford Jr High	8405 Jackman Rd RM 15	Temperance	MI
CH05291Z	Active	BPS-H80-029904	Family Medical Center of Michigan Inc	Family Medical Center - Wagar Middle School	11270 Grafton Rd Rm 215	Carleton	MI

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH052910	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	10/01/2024
CH052910	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	10/01/2024
CH052910	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	10/01/2024
CH052910	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	10/01/2024
CH052910	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	10/01/2024
CH052910	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	10/01/2024
CH052910	AHSSHC	EXPEDIEN RX PHARMACY	5050 WESLEY RD STE 120	APOPKA	FL	32712	01/01/2020	07/14/2023
CH052910	AMAZON PHARMACY #001	4500 S PLEASANT VALLEY RD STE 201		AUSTIN	TX	78744-2911	01/01/2020	07/14/2023
CH052910	APEX DRUG STORES, INC.	RITE AID #4405	1200 SOUTH MAIN ST STE A	ADRIAN	MI	49221	04/01/2013	12/07/2023
CH052910	AZ PHARMACY, LLC	DBA AMAZON PHARMACY #002	3809 E WATKINS ST	PHOENIX	AZ	85034	01/01/2020	07/14/2023
CH052910	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4900 PROSPECTUS DR STE 300		DURHAM	NC	27713	01/01/2024
CH052910	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	376 NORTHLAKE BLVD		ALTAMONTE SPRINGS	FL	32701-5261	01/01/2024
CH052910	CAN-AM RX INC.	DBA ADRIAN MEDICAL PHARMACY	142 E MAUMEE ST STE 5	ADRIAN	MI	49221-2735	01/01/2024
CH052910	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	10/01/2021
CH052910	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	10/01/2021
CH052910	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	10/01/2021
CH052910	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	10/01/2021
CH052910	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	10/01/2021
CH052910	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	10/01/2021
CH052910	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	10/01/2021
CH052910	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	10/01/2021
CH052910	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	10/01/2021
CH052910	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	10/01/2021
CH05291A	CARLETON DRUGS		201 MEDICAL CENTER DRIVE	CARLETON	MI	48117	08/15/2005
CH052910	CARLETON DRUGS	201 MEDICAL CENTER DR		CARLETON	MI	48117	04/05/2016
CH052910	CRARY DRUG	8941 LEWIS AVE		TEMPERANCE	MI	48182-1656	02/08/2005	07/25/2019
CH052910	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	10/01/2021
CH052910	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	10/01/2021
CH052910	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	10/01/2021
CH052910	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	10/01/2021
CH052910	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	10/01/2024
CH052910	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	10/01/2024
CH052910	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	10/01/2024
CH052910	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	10/01/2024
CH052910	GENOA HEALTHCARE LLC	1003 SOUTH RAISINVILLE ROAD		MONROE	MI	48161	07/01/2025
CH052910	HOMETOWN PHARMACY #25	15483 S DIXIE HWY		MONROE	MI	48161-3953	10/01/2015	04/30/2022
CH052910	HOMETOWN PHARMACY #26	1144 N MONROE ST		MONROE	MI	48162-3190	10/01/2015	04/30/2022
CH052910	HOMETOWN PHARMACY #27	811 N MACOMB ST		MONROE	MI	48162-2929	07/01/2015	07/26/2019
CH052910	KROGER CO OF MICHIGAN #577	571 E. MONROE STREET		DUNDEE	MI	48131	07/01/2013
CH052910	KROGER CO OF MICHIGAN #578	850 SOUTH MONROE STREET		MONROE	MI	48161	07/01/2013
CH052910	KROGER CO OF MICHIGAN #579	3833 NORTH DIXIE HIGHWAY		MONROE	MI	48162	07/01/2013
CH052910	KROGER COLUMBUS CENTRAL FILL #019	2270 RICKENBACKER PKWY W		COLUMBUS	OH	43217	01/01/2020
CH052910	KROGER PHARMACY	3462 W. STERNS ROAD		LAMBERTVILLE	MI	48144	07/01/2013
CH052910	KROGER PHARMACY #16810	833 W. ALEXIS ROAD		TOLEDO	OH	43612	07/01/2013
CH052910	M.N. PHARMACY LLC	DBA AMAZON PHARMACY #003	6701 NW 7TH ST., STE. #199	MIAMI	FL	33126	01/01/2020	07/14/2023
CH052910	MEIJER DISTRIBUTION INC #90	2721 WALKER AVE NW		GRAND RAPIDS	MI	49544	04/01/2019	12/29/2023
CH052910	MEIJER DISTRIBUTION INC #90	2721 WALKER AVE NW		GRAND RAPIDS	MI	49544	01/01/2025
CH052910	MEIJER INC #45	217 EAST US223		ADRIAN	MI	49221	04/01/2019	12/29/2023
CH052910	MEIJER INC #45	217 EAST US223		ADRIAN	MI	49221	01/01/2025
CH052910	MEIJER INC. #67	1700 TELEGRAPH RD		MONROE	MI	48162	04/01/2019	12/29/2023
CH052910	MEIJER INC. #67	1700 TELEGRAPH RD		MONROE	MI	48162	01/01/2025
CH052910	MEIJER PHARMACY #118	1500 E. ALEXIS ROAD		TOLEDO	OH	43612-3952	04/01/2019	12/29/2023
CH052910	MEIJER PHARMACY #464	41255 COCA COLA DR.		BELLEVILLE	MI	48111-1827	04/01/2019	12/29/2023
CH052910	MEIJER PHARMACY #464	41255 COCA COLA DR.		BELLEVILLE	MI	48111-1827	01/01/2025
CH052910	MEIJER STORES LIMITED PARTNERSHIP	D/B/A MEIJER PHARMACY #463	1515 PROFIT DR.	FORT WAYNE	IN	46808	04/01/2019	12/29/2023
CH052910	MEIJER STORES LIMITED PARTNERSHIP	D/B/A MEIJER PHARMACY #463	1515 PROFIT DR.	FORT WAYNE	IN	46808	01/01/2025
CH05291C	MERCY MEMORIAL MACOMB PHARMACY	730 N MACOMB ST STE 305		MONROE	MI	48162-2904	05/15/2010	04/01/2019
CH052910	OHIO CVS STORES, L.L.C.	CVS/PHARMACY #11155	2104 S. BYRNE ROAD	TOLEDO	OH	43614	04/01/2021
CH052910	OHIO CVS STORES, L.L.C.	CVS/PHARMACY # 10246	4121 MONROE STREET	TOLEDO	OH	43606	04/01/2021
CH052910	PERRY DRUG STORES, INC.	RITE AID #4331	507 SOUTH TELEGRAPH ROAD	MONROE	MI	48161	04/01/2013	02/05/2019
CH052910	PERRY DRUG STORES, INC.	RITE AID #4322	32905 FORT RD	ROCKWOOD	MI	48173-1112	01/01/2019	08/14/2024
CH052910	PILLPACK LLC	DBA PILLPACK BY AMAZON PHARMACY	250 COMMERCIAL ST STE 2012	MANCHESTER	NH	03101	01/01/2020	07/14/2023
CH052910	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	10/01/2021	10/01/2022
CH052910	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	10/01/2021
CH052910	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #11338	10160 INTERNATIONAL BLVD.	WEST CHESTER	OH	45246	10/01/2021
CH052910	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	10/01/2021
CH052910	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY OR CARELONRX SPECIALTY	ONE WATERFRONT PLAZA 500 ALA MOANA BLVD., BLDG 1	HONOLULU	HI	96813	10/01/2021
CH052910	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	10/01/2021
CH052910	RITE AID OF MICHIGAN, INC.	RITE AID #7700	7358 SECOR ROAD	LAMBERTVILLE	MI	48144	04/01/2013	08/14/2024
CH052910	RITE AID OF OHIO, INC.	RITE AID #2309	1012 WEST SYLVANIA AVENUE	TOLEDO	OH	43612	04/01/2013	08/14/2024
CH052910	RIVER MEDICAL PHARMACY LLC	4752 RESEARCH DR		SAN ANTONIO	TX	78240-5002	01/01/2024
CH052910	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	04/01/2020
CH052910	WAL-MART PHARMACY 10-1790	2150 N TELEGRAPH RD		MONROE	MI	48162	04/01/2021	01/15/2021
CH052910	WAL-MART PHARMACY 10-1790	2150 N TELEGRAPH RD		MONROE	MI	48162	01/01/2022
CH052910	WAL-MART PHARMACY 10-1836	1601 EAST U.S. 223		ADRIAN	MI	49221	07/01/2013
CH052910	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	04/01/2020
CH052910	WALGREEN CO	DBA: WALGREENS #12288	100 CABELAS BLVD., E	DUNDEE	MI	48131	07/12/2011
CH052910	WALGREEN CO	DBA: WALGREENS #10804	7420 SECOR ROAD	LAMBERTVILLE	MI	48144	07/12/2011
CH052910	WALGREEN CO.	DBA: WALGREENS #12820	1330 W CHICAGO BLVD	TECUMSEH	MI	49286-9769	07/12/2011
CH052910	WALGREEN CO.	DBA: WALGREENS # 05321	484 SOUTH TELEGRAPH ROAD	MONROE	MI	48161	07/12/2011
CH052910	WALGREEN CO.	DBA: WALGREENS # 06168	4580 MONROE ST	TOLEDO	OH	43613	07/12/2011
CH052910	WALGREEN CO.	DBA: WALGREENS # 02023	1285 N MONROE ST	MONROE	MI	48162-3115	07/12/2011
CH052910	WALGREEN CO.	DBA: WALGREENS # 07319	706 S MAIN STREET	ADRIAN	MI	49221-3722	07/12/2011
CH052910	WALGREEN CO.	DBA: WALGREENS # 09337	5815 SECOR RD	TOLEDO	OH	43623-1421	07/12/2011
CH052910	WALGREEN CO.	DBA: WALGREENS #10611	6636 WEST CENTRAL	TOLEDO	OH	43617	07/27/2011	01/23/2017
CH052910	WALGREEN CO.	DBA: WALGREENS # 05324	1330 N REYNOLDS ROAD	TOLEDO	OH	43615	09/21/2011
CH052910	WALGREEN CO.	DBA: WALGREENS # 05906	2562 NAVARRE AVE	OREGON	OH	43616	09/21/2011
CH052910	WALGREEN CO.	DBA: WALGREENS # 05168	23007 TELEGRAPH RD.	BROWNSTOWN	MI	48134	09/21/2011
CH052910	WALGREEN CO.	DBA: WALGREENS # 05169	1700 WEST ROAD	TRENTON	MI	48183	08/14/2024
CH052910	Walgreens #21423	Walgreens Central Fill #21423	6275 Winchester Blvd	Canal WInchester	OH	43110-6537	01/01/2024
CH052910	WALGREENS SPECIALTY PHARMACY, LLC	ALLIANCERX WALGREENS PRIME #12314	9775 SW GEMINI DR, STE 1	BEAVERTON	OR	97008	10/01/2021	11/05/2021
CH052910	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	10/01/2021
CH052910	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	10/01/2021
CH052910	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	10/01/2021
CH052910	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2023
CH052910	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024
CH052910	WOODWARD DETROIT CVS, L.L.C.	DBA: CVS/PHARMACY # 08013	1003 N. MAIN ST.	ADRIAN	MI	49221	07/01/2017
CH052910	WOODWARD DETROIT CVS, L.L.C.	DBA: CVS/PHARMACY # 08025	807 WEST CHICAGO BLVD.	TECUMSEH	MI	49286	04/01/2021
CH052910	WOODWARD DETROIT CVS, L.L.C.	DBA: CVS/PHARMACY # 08042	10915 BELLEVILLE RD	VAN BUREN TWP	MI	48111	04/01/2021
CH052910	WOODWARD DETROIT CVS, L.L.C.	DBA: CVS/PHARMACY # 08072	27000 TELEGRAPH RD	FLAT ROCK	MI	48134-1657	04/01/2021
CH052910	WOODWARD DETROIT CVS, LLC	DBA: CVS/PHARMACY # 08198	919 S. MONROE ST	MONROE	MI	48161	10/01/2023

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/22/2024 1:17:08 PM	3/4/2025 2:48:05 PM	3/4/2025 2:48 PM
Details	Last Recertification Date	Update	Recertification	2/14/2023 10:06:04 AM	2/22/2024 1:17:08 PM	2/22/2024 1:17 PM
Contacts	Authorizing Official	Update	Change Request	Croley, Chris C.F.O. Family Medical Center of Michigan 7348473802-1434	LARKINS, ED CEO Family Medical Center of Michigan, Inc. 7348473802-1412	7/14/2023 12:26 PM
Contacts	Primary Contact	Update	Change Request	LARKINS, ED CEO Family Medical Center of Michigan, Inc. 7348473802-1412	Terrill, Zach Director of Pharmacy Family Medical Center of Michigan, Inc. 5172631800-1215	7/14/2023 12:26 PM
Details	Last Recertification Date	Update	Recertification	2/23/2022 1:36:45 PM	2/14/2023 10:06:04 AM	2/14/2023 10:06 AM
Details	Last Recertification Date	Update	Recertification	2/17/2021 5:41:15 PM	2/23/2022 1:36:45 PM	2/23/2022 1:36 PM
Details	Last Recertification Date	Update	Recertification		2/17/2021 5:41:15 PM	2/17/2021 5:41 PM
Details	State	Update		Approved	Active	10/1/2020 12:01 AM
Contacts	Signed By	Insert	New Registration		Croley, Chris C.F.O. Family Medical Center of Michigan 7348473802-1434	7/29/2020 1:23 PM
Details	340B ID	Update	New Registration		CH05291Z	7/29/2020 1:23 PM
Dates	Participating Approval Date	Update	New Registration		7/29/2020 1:23:25 PM	7/29/2020 1:23 PM
Details	State	Update	New Registration	Pending	Approved	7/29/2020 1:23 PM
Dates	Signed By Date	Update	New Registration		7/7/2020 12:31:33 PM	7/29/2020 1:23 PM
Dates	Start Date	Update	New Registration		10/1/2020 12:00:00 AM	7/29/2020 1:23 PM
Addresses	Main Address	Insert	New Registration		11270 Grafton Rd Rm 215 Carleton, MI 48117-9392	7/7/2020 12:31 PM
Contacts	Primary Contact	Insert	New Registration		LARKINS, ED CEO Family Medical Center of Michigan, Inc. 7348473802-1412	7/7/2020 12:31 PM
Contacts	Authorizing Official	Insert	New Registration		Croley, Chris C.F.O. Family Medical Center of Michigan 7348473802-1434	7/7/2020 12:31 PM
Details	Last Recertification Date	Insert	New Registration			7/7/2020 12:31 PM
Details	Grant Number	Insert	New Registration		H80CS00390	7/7/2020 12:31 PM
Details	340B ID	Insert	New Registration			7/7/2020 12:31 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/7/2020 12:31 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/7/2020 12:31 PM
Details	Medicare Provider Number	Insert	New Registration			7/7/2020 12:31 PM
Details	Entity Name	Insert	New Registration		Family Medical Center of Michigan Inc	7/7/2020 12:31 PM
Details	Program Code	Insert	New Registration		CH	7/7/2020 12:31 PM
Details	Entity Subname	Insert	New Registration		Family Medical Center - Wagar Middle School	7/7/2020 12:31 PM
Dates	Participating Approval Date	Insert	New Registration			7/7/2020 12:31 PM
Details	State	Insert	New Registration		Pending	7/7/2020 12:31 PM
Dates	Registration Date	Insert	New Registration		7/7/2020 12:31:30 PM	7/7/2020 12:31 PM
Dates	Signed By Date	Insert	New Registration			7/7/2020 12:31 PM
Dates	Start Date	Insert	New Registration			7/7/2020 12:31 PM
Terminations	Termination Comments	Insert	New Registration			7/7/2020 12:31 PM
Terminations	Termination Date	Insert	New Registration			7/7/2020 12:31 PM
Terminations	Termination Effective Date	Insert	New Registration			7/7/2020 12:31 PM
Terminations	Termination Reason	Insert	New Registration			7/7/2020 12:31 PM

340B Drug Pricing Program Database