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MCLEAN PHARMACY
CH05316D THUNDER BAY COMMUNITY HEALTH SERVICE, INCORPORATED
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Covered Entity Details
Entity Name
THUNDER BAY COMMUNITY HEALTH SERVICE, INCORPORATED
Subdivision Name
THUNDER BAY COMMUNITY HEALTH SERVICE - ROGERS CITY
Type
HRSA-Funded Health Center
340B ID
CH05316D
Entity Address
205 S Bradley Hwy
Rogers City, MI 49779-2137
Grant Number
H80CS00402
Participating Start Date
1/1/2002
Last Recertification Date
2/20/2025
Pharmacy Details
Pharmacy Name
MCLEAN PHARMACY
Pharmacy Address
229 N THIRD ST
ROGERS CITY, MI 49779-1610
Pharmacy Comments
Contract Details
Approval Date
10/1/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/15/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
MICHELLE STYMA, CEO
(989) 742-4583
Contract Pharmacy Representative
McLean Pharmacy
Tom Gajewski, Pharmacist/Owner
(989) 734-4701
Signed By Date
10/1/2014
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