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PERRY DRUG STORES, INC.
CHC29011-00 PACKARD HEALTH, INC.
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Covered Entity Details
Entity Name
PACKARD HEALTH, INC.
Subdivision Name
Packard Health Carpenter
Type
HRSA-Funded Health Center
340B ID
CHC29011-00
Entity Address
2650 Carpenter Road
Ann Arbor, MI 48108
Grant Number
H80CS29011
Participating Start Date
4/1/2016
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
PERRY DRUG STORES, INC.
Pharmacy Address
RITE AID #4363
753 SOUTH GROVE STREET
YPSILANTI, MI 48198
Pharmacy Comments
Contract Details
Approval Date
7/11/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/23/2025
Pharmacy closed
Contacts
Covered Entity Signing Official
Mark Jacoby, CFO
(734) 971-1073
Contract Pharmacy Representative
Rite Aid
Lisa Foster, Manager-Pharmacy
(717) 214-2518
Signed By Date
7/11/2019
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