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WAL-MART PHARMACY 10-2358
SCH230036-00 MidMichigan Medical Center-Alpena
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Covered Entity Details
Entity Name
MidMichigan Medical Center-Alpena
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH230036-00
Entity Address
1501 W. CHISHOLM
ALPENA, MI 49707
Medicare Provider Number
230036
Participating Start Date
10/1/2018
Last Recertification Date
11/9/2017
Entity Termination Date
7/1/2019
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2358
Pharmacy Address
1180 M-32 WEST
ALPENA, MI 49707
Pharmacy Comments
Contract Details
Approval Date
10/2/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/31/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
George J Smart, Vice President of Finance/ IT Services
(989) 356-7246
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
10/2/2018
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