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MEIJER DISTRIBUTION INC #90
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
MEIJER DISTRIBUTION INC #90
Pharmacy Address
2721 WALKER AVE NW
GRAND RAPIDS, MI 49544
Pharmacy Comments
Distribution Center
Contract Details
Approval Date
1/8/2021
Contract Begin Date
1/28/2021
Carve-In Effective Date
Contract Comments
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
1/8/2021
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