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PDS-I MICHIGAN, INC.
CAH231331-00 SPARROW IONIA HOSPITAL
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Covered Entity Details
Entity Name
SPARROW IONIA HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH231331-00
Entity Address
3565 S. State Rd
IONIA, MI 48846
Medicare Provider Number
231331
Participating Start Date
10/1/2010
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
PDS-I MICHIGAN, INC.
Pharmacy Address
RITE AID #4326
431 WEST LINCOLN HIGHWAY
IONIA, MI 48846
Pharmacy Comments
Contract Details
Approval Date
4/12/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/11/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
WILLIAM ROESER, PRESIDENT AND CHIEF EXECUTIVE OFFICER
(616) 523-1712
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President, Managed Care
(717) 975-5968
Signed By Date
4/12/2019
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