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RITE AID OF MICHIGAN, INC.
RRC230208-00 Sparrow Carson Hospital
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Covered Entity Details
Entity Name
Sparrow Carson Hospital
Subdivision Name
Type
Rural Referral Center
340B ID
RRC230208-00
Entity Address
406 EAST ELM STREET
CARSON CITY, MI 48811
Medicare Provider Number
230208
Participating Start Date
10/1/2019
Last Recertification Date
Entity Termination Date
10/1/2020
Pharmacy Details
Pharmacy Name
RITE AID OF MICHIGAN, INC.
Pharmacy Address
RITE AID #1527
507 N LAFAYETTE STREET
GREENVILLE, MI 48838
Pharmacy Comments
Contract Details
Approval Date
9/13/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Mark Brisboe, Chief Financial Officer
(616) 523-1702
Contract Pharmacy Representative
PDS I Michigan, Inc
Allison Farrell, Senior Vice President
(717) 214-8834
Signed By Date
9/13/2019
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