Contract Pharmacy Details

PERRY DRUG STORES, INC.
DSH230195 ST. JOHN MACOMB-OAKLAND HOSPITAL DBA Henry Ford Health Warren Hospital

Covered Entity Details

Entity Name

ST. JOHN MACOMB-OAKLAND HOSPITAL DBA Henry Ford Health Warren Hospital

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH230195

Entity Address

11800 TWELVE MILE RD.
WARREN, MI 48093

Medicare Provider Number

230195

Participating Start Date

1/1/2021

Last Recertification Date

8/15/2024

Pharmacy Details

Pharmacy Name

PERRY DRUG STORES, INC.

Pharmacy Address

RITE AID #4339
11743 15 MILE ROAD
STERLING HEIGHTS, MI 48312

Pharmacy Comments

Contract Details

Approval Date

4/15/2021

Contract Begin Date

7/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/1/2023
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Douglas Winner, CFO, Acute Care Operations
(586) 753-0662

Contract Pharmacy Representative

Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968

Signed By Date

4/15/2021

340B Drug Pricing Program Database