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ASPIRUS KEWEENAW
CHC26511-05 UPPER GREAT LAKES FAMILY HEALTH CENTER
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Covered Entity Details
Entity Name
UPPER GREAT LAKES FAMILY HEALTH CENTER
Subdivision Name
Ontonagon Family Health Center
Type
HRSA-Funded Health Center
340B ID
CHC26511-05
Entity Address
751 7th Avenue South
Ontonagon, MI 49953
Grant Number
H80CS26511
Participating Start Date
7/1/2014
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
ASPIRUS KEWEENAW
Pharmacy Address
DBA ASPIRUS KEWEENAW PHARMACY
205 OSCEOLA ST
LAURIUM, MI 49913
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
Donald A. Simila, CEO
(906) 481-8571
Contract Pharmacy Representative
Aspirus
Jessica Bessner, Director of Pharmacy
(906) 337-6527
Signed By Date
4/12/2019
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