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HOMETOWN PHARMACY #57 - WADHAMS
CH05220AF DOWNRIVER COMMUNITY SERVICES INC
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Covered Entity Details
Entity Name
DOWNRIVER COMMUNITY SERVICES INC
Subdivision Name
DCS Port Huron Medical Clinic
Type
HRSA-Funded Health Center
340B ID
CH05220AF
Entity Address
1011 Military St
Port Huron, MI 48060-5416
Grant Number
H80CS00497
Participating Start Date
4/1/2011
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
HOMETOWN PHARMACY #57 - WADHAMS
Pharmacy Address
5277 LAPEER RD
KIMBALL, MI 48074-1422
Pharmacy Comments
Contract Details
Approval Date
1/6/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mike Baranowski, CEO
(586) 270-8055
Contract Pharmacy Representative
HomeTown Pharmacy Inc
Rebekah L DesArmo, Director
(231) 301-0354 Ext: 8038
Signed By Date
1/6/2020
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