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THUNDER BAY PHARMACY
CH053160 THUNDER BAY COMMUNITY HEALTH SERVICE, INCORPORATED
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Covered Entity Details
Entity Name
THUNDER BAY COMMUNITY HEALTH SERVICE, INCORPORATED
Subdivision Name
Thunder Bay Community Health Services Hillman
Type
HRSA-Funded Health Center
340B ID
CH053160
Entity Address
15774 State St.
Hillman, MI 49746
Grant Number
H80CS00402
Participating Start Date
10/1/1999
Last Recertification Date
2/20/2025
Pharmacy Details
Pharmacy Name
THUNDER BAY PHARMACY
Pharmacy Address
11899 M-32
PO BOX 850
ATLANTA, MI 49709
Pharmacy Comments
Contract Details
Approval Date
1/6/2005
Contract Begin Date
1/6/2005
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/15/2016
Agreement registered in error
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
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