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RITE AID OF MICHIGAN, INC.
DSH230080 MCLAREN CENTRAL MICHIGAN
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Covered Entity Details
Entity Name
MCLAREN CENTRAL MICHIGAN
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230080
Entity Address
1221 SOUTH DRIVE
MT PLEASANT, MI 48858
Medicare Provider Number
230080
Participating Start Date
10/1/2021
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
RITE AID OF MICHIGAN, INC.
Pharmacy Address
RITE AID #3320
425 N FIFTH STREET
PO BOX 732
ROSCOMMON, MI 48653
Pharmacy Comments
Contract Details
Approval Date
7/27/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/3/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Tara Soules, Chief Financial Officer
(989) 772-6818
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President Managed Care
(717) 975-5978
Signed By Date
7/15/2021
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