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FAMILY FARE PHARMACY #1992
DSH230217 Oaklawn Hospital
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Covered Entity Details
Entity Name
Oaklawn Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230217
Entity Address
200 North Madison
Marshall, MI 49068
Medicare Provider Number
230217
Participating Start Date
10/1/2011
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
FAMILY FARE PHARMACY #1992
Pharmacy Address
FAMILY FARE LLC
1406 N EATON ST
ALBION, MI 49224-9470
Pharmacy Comments
Contract Details
Approval Date
7/12/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Gregg M. Beeg, Interim President and CEO
(269) 789-3924
Contract Pharmacy Representative
Prevos Family Markets, Inc., Family Fare, LLC
Kristina Rooney, Pharmacy Contract Admin
(616) 878-2761
Signed By Date
7/12/2018
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