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MK STORES INC DBA - SNYDERS DRUG #212
CHC26511-03 UPPER GREAT LAKES FAMILY HEALTH CENTER
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Covered Entity Details
Entity Name
UPPER GREAT LAKES FAMILY HEALTH CENTER
Subdivision Name
Ice Lake Family Health Center
Type
HRSA-Funded Health Center
340B ID
CHC26511-03
Entity Address
1500 W Ice Lake Rd
Iron River, MI 49935
Grant Number
H80CS26511
Participating Start Date
7/1/2014
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
MK STORES INC DBA - SNYDERS DRUG #212
Pharmacy Address
56905 STATION DR
CALUMET, MI 49913-2903
Pharmacy Comments
Contract Details
Approval Date
10/14/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Donald A. Simila, CEO
(906) 481-8571
Contract Pharmacy Representative
MKStores
Mike Russell, Director of Pharmacy
(906) 485-5592
Signed By Date
10/14/2019
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