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SUPERX DRUGS CORP
RRC230080-00 McLaren Central Michigan
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Covered Entity Details
Entity Name
McLaren Central Michigan
Subdivision Name
Type
Rural Referral Center
340B ID
RRC230080-00
Entity Address
1221 South Drive
Mount Pleasant, MI 48858
Medicare Provider Number
230080
Participating Start Date
10/1/2012
Last Recertification Date
9/3/2020
Entity Termination Date
10/1/2021
Pharmacy Details
Pharmacy Name
SUPERX DRUGS CORP
Pharmacy Address
DBA THE KROGER CO OF MI 600
540 S MAIN ST
LAPEER, MI 48446
Pharmacy Comments
Contract Details
Approval Date
4/15/2021
Contract Begin Date
6/4/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2021
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Tara Soules, Chief Financial Officer
(989) 772-6818
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
4/15/2021
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