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PENINSULA PHARMACY PLUS
CHC26511-07 UPPER GREAT LAKES FAMILY HEALTH CENTER
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Covered Entity Details
Entity Name
UPPER GREAT LAKES FAMILY HEALTH CENTER
Subdivision Name
Lake Linden Family Health Center
Type
HRSA-Funded Health Center
340B ID
CHC26511-07
Entity Address
945 9TH ST
LAKE LINDEN, MI 49945
Grant Number
H80CS26511
Participating Start Date
7/1/2014
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
PENINSULA PHARMACY PLUS
Pharmacy Address
PENINSULA PHAMRACY PLUS
300 N. MCCLELLAN AVE
MARQUETTE, MI 49855
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
2/17/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Donald A. Simila, CEO
(906) 481-8571
Contract Pharmacy Representative
Peninsula Pharmacy, Inc
Tyler Jenema, Owner
(906) 225-3902
Signed By Date
10/15/2020
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