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WAL-MART PHARMACY 10-1809
RRC230037-00 Hillsdale Community Health Center
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Covered Entity Details
Entity Name
Hillsdale Community Health Center
Subdivision Name
Hillsdale Hospital
Type
Rural Referral Center
340B ID
RRC230037-00
Entity Address
168 S. Howell Street
Hillsdale, MI 49242
Medicare Provider Number
230037
Participating Start Date
7/1/2012
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1809
Pharmacy Address
701 OLDS STREET
JONESVILLE, MI 49250
Pharmacy Comments
Contract Details
Approval Date
10/10/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mark Gross, CFO
(517) 437-5232
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
10/10/2018
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