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PERRY DRUG STORES, INC.
CH052910 FAMILY MEDICAL CENTER OF MICHIGAN INC
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Covered Entity Details
Entity Name
FAMILY MEDICAL CENTER OF MICHIGAN INC
Subdivision Name
FAMILY MEDICAL CENTER OF MI, INC
Type
HRSA-Funded Health Center
340B ID
CH052910
Entity Address
8765 Lewis Ave
Temperance, MI 48182-9583
Grant Number
H80CS00390
Participating Start Date
10/1/2001
Last Recertification Date
3/6/2025
Pharmacy Details
Pharmacy Name
PERRY DRUG STORES, INC.
Pharmacy Address
RITE AID #4322
32905 FORT RD
ROCKWOOD, MI 48173-1112
Pharmacy Comments
Contract Details
Approval Date
10/10/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/14/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
ED LARKINS, CEO
(734) 847-3802 Ext: 1412
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968
Signed By Date
10/10/2018
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