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PERRY DRUG STORES, INC.
CH050290 MIDMICHIGAN HEALTH SERVICES, INC
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Covered Entity Details
Entity Name
MIDMICHIGAN HEALTH SERVICES, INC
Subdivision Name
MIDMICHIGAN HEALTH PARK - HOUGHTON LAKE
Type
HRSA-Funded Health Center
340B ID
CH050290
Entity Address
9249 W Lake City RD
Houghton Lake, MI 48629-9602
Grant Number
H80CS00190
Participating Start Date
1/1/2004
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
PERRY DRUG STORES, INC.
Pharmacy Address
RITE AID #4488
120 EAST CEDAR AVE
GLADWIN, MI 48624
Pharmacy Comments
Contract Details
Approval Date
1/2/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/1/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
Jim Raschke, Executive Director
(989) 422-2105
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968
Signed By Date
1/2/2019
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