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MEIJER STORES LIMITED PARTNERSHIP
CH051020 HACKLEY COMMUNITY CARE CENTER INC
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Covered Entity Details
Entity Name
HACKLEY COMMUNITY CARE CENTER INC
Subdivision Name
Hackley Community Care Baker Site
Type
HRSA-Funded Health Center
340B ID
CH051020
Entity Address
2700 Baker St
Muskegon, MI 49444-2157
Grant Number
H80CS00684
Participating Start Date
1/1/2001
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
MEIJER STORES LIMITED PARTNERSHIP
Pharmacy Address
D/B/A MEIJER PHARMACY #463
1515 PROFIT DR.
FORT WAYNE, IN 46808
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
Valerie J Blondin, CFO
(231) 733-6657
Contract Pharmacy Representative
Meijer
Katy Diaz, Pharmacy Business Associate
(616) 791-3127
Signed By Date
10/10/2018
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