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ANN ARBOR PHARMACY LLC
CHC29011-00 PACKARD HEALTH, INC.
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Covered Entity Details
Entity Name
PACKARD HEALTH, INC.
Subdivision Name
Packard Health Carpenter
Type
HRSA-Funded Health Center
340B ID
CHC29011-00
Entity Address
2650 Carpenter Road
Ann Arbor, MI 48108
Grant Number
H80CS29011
Participating Start Date
4/1/2016
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
ANN ARBOR PHARMACY LLC
Pharmacy Address
2418 E STADIUM BLVD
ANN ARBOR, MI 48104
Pharmacy Comments
Contract Details
Approval Date
4/5/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/26/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Mark Jacoby, CFO
(734) 971-1073
Contract Pharmacy Representative
340Basics
Camila Repetto, Account Manager
(888) 356-6225
Signed By Date
4/5/2019
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