Contract Pharmacy Details

PERRY DRUG STORES, INC.
CH051980 ALCONA CITIZENS FOR HEALTH, INC.

Covered Entity Details

Entity Name

ALCONA CITIZENS FOR HEALTH, INC.

Subdivision Name

Alcona Health Center-Lincoln Services

Type

HRSA-Funded Health Center

340B ID

CH051980

Entity Address

177 N Barlow Rd
Harrisville, MI 48740

Grant Number

H80CS00679

Participating Start Date

1/1/2002

Last Recertification Date

2/19/2025

Pharmacy Details

Pharmacy Name

PERRY DRUG STORES, INC.

Pharmacy Address

RITE AID #4502
211 E LAKE STREET
TAWAS CITY, MI 48763-9305

Pharmacy Comments

Contract Details

Approval Date

1/6/2014

Contract Begin Date

4/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

8/20/2024
Pharmacy closed

Contacts

Covered Entity Signing Official

Christine M. Baumgardner, CEO
(989) 736-9868

Contract Pharmacy Representative

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

Signed By Date

1/6/2014

340B Drug Pricing Program Database