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MEDSHOP PHARMACY LLC
RWI48201A Matrix Human Services
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Covered Entity Details
Entity Name
Matrix Human Services
Subdivision Name
Type
Ryan White Part A
340B ID
RWI48201A
Entity Address
1964 11 Mile Road
Berkley, MI 48072
Grant Number
H89HA00021
Participating Start Date
10/1/2015
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
MEDSHOP PHARMACY LLC
Pharmacy Address
1964 W 11 MILE RD
SUITE C
BERKLEY, MI 48072
Pharmacy Comments
Contract Details
Approval Date
4/12/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
David Perkins, Vice President of Health Care Services
(248) 819-0489
Contract Pharmacy Representative
Nota Consulting Group, LLC
Fungisai Nota, 340B Program Manager
(610) 742-7763
Signed By Date
4/12/2019
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