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MYMICHIGAN MEDICAL CENTER MIDLAND
CAH231325-00 MyMichigan Medical Center Gladwin
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Covered Entity Details
Entity Name
MyMichigan Medical Center Gladwin
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH231325-00
Entity Address
515 QUARTER STREET
GLADWIN, MI 48624
Medicare Provider Number
231325
Participating Start Date
8/31/2010
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
MYMICHIGAN MEDICAL CENTER MIDLAND
Pharmacy Address
DBA MYMICHIGAN MEDICAL CENTER MT. PLEASA
4851 E PICKARD ST
MOUNT PLEASANT, MI 48858
Pharmacy Comments
Contract Details
Approval Date
7/2/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/31/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Ray Stover, Regional President
(989) 246-6203
Contract Pharmacy Representative
MidMichigan Health
Bryan Rex Cross, President
(989) 839-1322
Signed By Date
7/2/2018
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