Contract Pharmacy Details

HILLMAN PHARMACY INC
CH05316C THUNDER BAY COMMUNITY HEALTH SERVICE, INCORPORATED

Covered Entity Details

Entity Name

THUNDER BAY COMMUNITY HEALTH SERVICE, INCORPORATED

Subdivision Name

THUNDER BAY COMM HEALTH SERVICE - ATLANTA

Type

HRSA-Funded Health Center

340B ID

CH05316C

Entity Address

11899 M 32
Atlanta, MI 49709-9374

Grant Number

H80CS00402

Participating Start Date

10/1/1999

Last Recertification Date

2/20/2025

Pharmacy Details

Pharmacy Name

HILLMAN PHARMACY INC

Pharmacy Address

601 STATE ST
HILLMAN, MI 49746

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

340B Drug Pricing Program Database