Contract Pharmacy Details

PERRY DRUG STORES, INC.
CH052910 FAMILY MEDICAL CENTER OF MICHIGAN INC

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

PERRY DRUG STORES, INC.

Pharmacy Address

RITE AID #4331
507 SOUTH TELEGRAPH ROAD
MONROE, MI 48161

Pharmacy Comments

Contract Details

Approval Date

3/13/2013

Contract Begin Date

4/1/2013

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

2/5/2019
Pharmacy closed

Contacts

Covered Entity Signing Official

Wendy Barnes, Group Vice President, Managed Care
(717) 730-8217

Contract Pharmacy Representative

Rite Aid
Tammy Royer, Group Vice President, Managed Care
(717) 730-8217

Signed By Date

1/15/2013

340B Drug Pricing Program Database