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WALGREEN CO.
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
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 10514
991 SOUTH MAIN ST
CHEBOYGAN, MI 49721-2219
Pharmacy Comments
Contract Details
Approval Date
1/6/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/22/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
MICHELLE STYMA, CEO
(989) 742-4583
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/6/2014
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