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WALGREEN CO.
CH050290 MIDMICHIGAN HEALTH SERVICES, INC
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Covered Entity Details
Entity Name
MIDMICHIGAN HEALTH SERVICES, INC
Subdivision Name
MIDMICHIGAN HEALTH PARK - HOUGHTON LAKE
Type
HRSA-Funded Health Center
340B ID
CH050290
Entity Address
9249 W Lake City RD
Houghton Lake, MI 48629-9602
Grant Number
H80CS00190
Participating Start Date
1/1/2004
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 06559
931 S SAGINAW RD
MIDLAND, MI 48640-4602
Pharmacy Comments
Contract Details
Approval Date
7/10/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jim Raschke, Executive Director
(989) 422-2105
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/10/2017
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