Contract Pharmacy Details

MEIJER, INC. #140
RRC230141-00 MCLAREN FLINT

Covered Entity Details

Entity Name

MCLAREN FLINT

Subdivision Name

Type

Rural Referral Center

340B ID

RRC230141-00

Entity Address

401 S. BALLENGER
FLINT, MI 48532

Medicare Provider Number

230141

Participating Start Date

12/22/2020

Last Recertification Date

8/26/2024

Pharmacy Details

Pharmacy Name

MEIJER, INC. #140

Pharmacy Address

1555 DEMILLE RD
LAPEER, MI 48446

Pharmacy Comments

Contract Details

Approval Date

12/22/2020

Contract Begin Date

12/22/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/10/2024
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

FRED KORTE, CFO
(248) 338-5691

Contract Pharmacy Representative

Meijer
Katy Diaz, Pharmacy Business Associate
(616) 791-3127

Signed By Date

12/21/2020

340B Drug Pricing Program Database