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MEIJER PHARMACY #302
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
MEIJER PHARMACY #302
Pharmacy Address
3630 US 41 W
MARQUETTE, MI 49855
Pharmacy Comments
Contract Details
Approval Date
1/3/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Donald A. Simila, CEO
(906) 481-8571
Contract Pharmacy Representative
Meijer
Kevin Hurn, Dir, Pharmacy Procurement and New Business
(616) 791-5185
Signed By Date
1/3/2020
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