Contract Pharmacy Details

WOODWARD DETROIT CVS, L.L.C.
SCH230222-00 MYMICHIGAN MEDICAL CENTER MIDLAND

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

WOODWARD DETROIT CVS, L.L.C.

Pharmacy Address

DBA CVS/PHARMACY # 10442
1015 S. SAGINAW RD.
MIDLAND, MI 48640

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

1/1/2025
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Bryan Rex Cross, President
(989) 839-1322

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

7/9/2020

340B Drug Pricing Program Database