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KROGER PHARMACY
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
KROGER PHARMACY
Pharmacy Address
3462 W. STERNS ROAD
LAMBERTVILLE, MI 48144
Pharmacy Comments
Contract Details
Approval Date
4/10/2013
Contract Begin Date
7/1/2013
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ED LARKINS, CEO
(734) 847-3802 Ext: 1412
Contract Pharmacy Representative
Kroger
Mike Puccini, New Business Development Manager
(513) 762-4672
Signed By Date
4/10/2013
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