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THE KROGER CO OF MICHIGAN 465
DSH230207 McLaren Oakland
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Covered Entity Details
Entity Name
McLaren Oakland
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230207
Entity Address
50 N Perry St
Pontiac, MI 48342-2217
Medicare Provider Number
230207
Participating Start Date
1/1/2005
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
THE KROGER CO OF MICHIGAN 465
Pharmacy Address
1821 SOUTH CEDAR
IMLAY CITY, MI 48444
Pharmacy Comments
Contract Details
Approval Date
10/15/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/25/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Lynn Marcotte, CFO
(248) 338-5691
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
10/15/2020
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