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WOODWARD DETROIT CVS, L.L.C.
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
WOODWARD DETROIT CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 08013
1003 N. MAIN ST.
ADRIAN, MI 49221
Pharmacy Comments
Contract Details
Approval Date
4/13/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ED LARKINS, CEO
(734) 847-3802 Ext: 1412
Contract Pharmacy Representative
CVS
Jeff Noone, Director
(412) 660-1513
Signed By Date
4/13/2017
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