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RITE AID OF MICHIGAN, INC.
CAH231324-00 EATON RAPIDS MEDICAL CENTER
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Covered Entity Details
Entity Name
EATON RAPIDS MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH231324-00
Entity Address
1500 S MAIN ST
EATON RAPIDS, MI 48827
Medicare Provider Number
231324
Participating Start Date
10/1/2017
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
RITE AID OF MICHIGAN, INC.
Pharmacy Address
RITE AID #1612
2263 CEDAR STREET
HOLT, MI 48842
Pharmacy Comments
Contract Details
Approval Date
1/15/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/22/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
Shari Glynn, Vice President of Finance/Chief Financial Officer
(517) 663-9456
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968
Signed By Date
1/15/2019
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