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RITE AID OF MICHIGAN, INC.
DSH230132 HURLEY MEDICAL CENTER
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Covered Entity Details
Entity Name
HURLEY MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230132
Entity Address
ONE HURLEY PLAZA
FLINT, MI 48503
Medicare Provider Number
230132
Participating Start Date
12/1/1992
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
RITE AID OF MICHIGAN, INC.
Pharmacy Address
RITE AID #3667
4001 DAVISON ROAD SUITE A
BURTON, MI 48509
Pharmacy Comments
Contract Details
Approval Date
1/14/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/1/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Melany Gavulic, President & CEO
(810) 262-6887
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President Managed Care
(717) 975-5978
Signed By Date
1/14/2021
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