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PERRY DRUG STORES, INC.
SCH230222-00 MYMICHIGAN MEDICAL CENTER MIDLAND
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Covered Entity Details
Entity Name
MYMICHIGAN MEDICAL CENTER MIDLAND
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH230222-00
Entity Address
4000 WELLNESS DRIVE
MIDLAND, MI 48670
Medicare Provider Number
230222
Participating Start Date
7/1/2020
Last Recertification Date
8/19/2024
Entity Termination Date
1/1/2025
Pharmacy Details
Pharmacy Name
PERRY DRUG STORES, INC.
Pharmacy Address
RITE AID #4488
120 EAST CEDAR AVE
GLADWIN, MI 48624
Pharmacy Comments
Contract Details
Approval Date
7/9/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/2/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
Bryan Rex Cross, President
(989) 839-1322
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968
Signed By Date
7/9/2020
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