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RITE AID OF MICHIGAN, INC.
DSH230217 Oaklawn Hospital
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Covered Entity Details
Entity Name
Oaklawn Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230217
Entity Address
200 North Madison
Marshall, MI 49068
Medicare Provider Number
230217
Participating Start Date
10/1/2011
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
RITE AID OF MICHIGAN, INC.
Pharmacy Address
RITE AID #4963
890 EAST MICHIGAN AVENUE
BATTLE CREEK, MI 49014
Pharmacy Comments
Contract Details
Approval Date
1/10/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/29/2021
Pharmacy closed
Contacts
Covered Entity Signing Official
Andrew James Poole, CFO
(269) 789-3936
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President, Managed Care
(717) 975-5968
Signed By Date
1/10/2020
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