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VG'S PHARMACY #1925
RRC230141-00 MCLAREN FLINT
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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
VG'S PHARMACY #1925
Pharmacy Address
710 S. MILL
CLIO, MI 48420-1491
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
4/24/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
FRED KORTE, CFO
(248) 338-5691
Contract Pharmacy Representative
SpartanNash
Eddie Garcia, Director of Pharmacy
(616) 878-2975
Signed By Date
12/21/2020
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