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MEIJER STORES LIMITED PARTNERSHIP
CHC26511-08 UPPER GREAT LAKES FAMILY HEALTH CENTER
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Covered Entity Details
Entity Name
UPPER GREAT LAKES FAMILY HEALTH CENTER
Subdivision Name
Menominee Family Health Center
Type
HRSA-Funded Health Center
340B ID
CHC26511-08
Entity Address
1110 10th Ave
Menominee, MI 49858
Grant Number
H80CS26511
Participating Start Date
10/1/2014
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
MEIJER STORES LIMITED PARTNERSHIP
Pharmacy Address
D/B/A MEIJER PHARMACY #463
1515 PROFIT DR.
FORT WAYNE, IN 46808
Pharmacy Comments
Contract Details
Approval Date
1/15/2020
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
1/15/2020
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