Contract Pharmacy Details

MEIJER PHARMACY #302
CHC26511-10 Upper Great Lakes Family Health Center

Covered Entity Details

Entity Name

Upper Great Lakes Family Health Center

Subdivision Name

Upper Great Lakes - Michigan State University Tele-Psychiatry

Type

HRSA-Funded Health Center

340B ID

CHC26511-10

Entity Address

E Fee Hall 965 Fee Road - Room A229
East Lansing, MI 48824-1316

Grant Number

H80CS26511

Participating Start Date

4/1/2018

Last Recertification Date

1/31/2022

Entity Termination Date

4/1/2022

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

Contract Termination Date
Termination Reason

4/1/2022
Covered Entity Terminated

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

340B Drug Pricing Program Database