Contract Pharmacy Details

COMMUNITY CARE PHARMACY
CH051020 HACKLEY COMMUNITY CARE CENTER INC

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

COMMUNITY CARE PHARMACY

Pharmacy Address

COMMUNITY CARE PHARMACY
2700 BAKER ST
MUSKEGON HEIGHTS, MI 49444

Pharmacy Comments

Contract Details

Approval Date

7/27/2011

Contract Begin Date

7/27/2011

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/25/2016
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

LINDA Collis JUAREZ, CEO
(231) 737-1335

Contract Pharmacy Representative

Wayne Kohn, Medical Director
(231) 737-1335

Signed By Date

7/20/2011

340B Drug Pricing Program Database