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RITE AID OF MICHIGAN, INC.
RRC230037-00 Hillsdale Community Health Center
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Covered Entity Details
Entity Name
Hillsdale Community Health Center
Subdivision Name
Hillsdale Hospital
Type
Rural Referral Center
340B ID
RRC230037-00
Entity Address
168 S. Howell Street
Hillsdale, MI 49242
Medicare Provider Number
230037
Participating Start Date
7/1/2012
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
RITE AID OF MICHIGAN, INC.
Pharmacy Address
RITE AID #2711
450 EAST CHICAGO STREET
COLDWATER, MI 49036
Pharmacy Comments
Contract Details
Approval Date
10/12/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/30/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
Mark Gross, CFO
(517) 437-5232
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968
Signed By Date
10/12/2020
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