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PGPA PHARMACY
CH05203A CHERRY STREET SERVICES, INC.
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Covered Entity Details
Entity Name
CHERRY STREET SERVICES, INC.
Subdivision Name
WESTSIDE HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH05203A
Entity Address
669 STOCKING AVE NW
GRAND RAPIDS, MI 49504
Grant Number
H80CS00770
Participating Start Date
7/1/2002
Last Recertification Date
2/24/2025
Pharmacy Details
Pharmacy Name
PGPA PHARMACY
Pharmacy Address
3544 MERIDIAN CROSSINGS
OKEMOS, MI 48864-6025
Pharmacy Comments
01/31/2013 addres line 1 update (was 3520 OKEMOS ROAD, SUITE 5)
Contract Details
Approval Date
7/9/2009
Contract Begin Date
7/9/2009
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
WILLIAM F. ADRIAN, PRESIDENT
(517) 381-8665
Signed By Date
5/18/2009
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