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WOODWARD DETROIT CVS, L.L.C.
RRC230227-00 MCLAREN MACOMB
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Covered Entity Details
Entity Name
MCLAREN MACOMB
Subdivision Name
Type
Rural Referral Center
340B ID
RRC230227-00
Entity Address
1000 HARRINGTON
MT. CLEMENS, MI 48043
Medicare Provider Number
230227
Participating Start Date
12/1/2020
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
WOODWARD DETROIT CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 08158
46850 ROMEO PLANK
MACOMB, MI 48044
Pharmacy Comments
Contract Details
Approval Date
11/10/2020
Contract Begin Date
12/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/8/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Brian Balutanski, Regional CFO
(586) 493-3044
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/15/2020
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