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WALGREEN CO.
CH052910 FAMILY MEDICAL CENTER OF MICHIGAN INC
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Covered Entity Details
Entity Name
FAMILY MEDICAL CENTER OF MICHIGAN INC
Subdivision Name
FAMILY MEDICAL CENTER OF MI, INC
Type
HRSA-Funded Health Center
340B ID
CH052910
Entity Address
8765 Lewis Ave
Temperance, MI 48182-9583
Grant Number
H80CS00390
Participating Start Date
10/1/2001
Last Recertification Date
3/6/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #10611
6636 WEST CENTRAL
TOLEDO, OH 43617
Pharmacy Comments
Contract Details
Approval Date
7/27/2011
Contract Begin Date
7/27/2011
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/23/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
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