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ESI MAIL PHARMACY SERVICE
SCH230081-00 Munson Healthcare Cadillac Hospital
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Covered Entity Details
Entity Name
Munson Healthcare Cadillac Hospital
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH230081-00
Entity Address
400 Hobart St
Cadillac, MI 49601
Medicare Provider Number
230081
Participating Start Date
7/1/2012
Last Recertification Date
8/19/2021
Entity Termination Date
4/1/2022
Pharmacy Details
Pharmacy Name
ESI MAIL PHARMACY SERVICE
Pharmacy Address
DBA EXPRESS SCRIPTS
7909 S HARDY DR STE 106
TEMPE, AZ 85284-1112
Pharmacy Comments
Contract Details
Approval Date
7/10/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Mark Hepler, CFO
(231) 935-6702
Contract Pharmacy Representative
Accredo Health Group Inc.
Tony Atkinson, Sales Director
(513) 581-7562
Signed By Date
7/10/2019
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