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MEIJER INC #257
CH051980 ALCONA CITIZENS FOR HEALTH, INC.
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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
MEIJER INC #257
Pharmacy Address
1201 LEARS ROAD
PETOSKEY, MI 49770
Pharmacy Comments
Contract Details
Approval Date
7/13/2015
Contract Begin Date
10/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/30/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Christine M. Baumgardner, CEO
(989) 736-9868
Contract Pharmacy Representative
Meijer
Jeff Romano, Hospital Programs
(616) 791-3171
Signed By Date
7/13/2015
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