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FAMILY FARE PHARMACY #1524
SCH230222-00 MYMICHIGAN MEDICAL CENTER MIDLAND
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Covered Entity Details
Entity Name
MYMICHIGAN MEDICAL CENTER MIDLAND
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH230222-00
Entity Address
4000 WELLNESS DRIVE
MIDLAND, MI 48670
Medicare Provider Number
230222
Participating Start Date
7/1/2020
Last Recertification Date
8/19/2024
Entity Termination Date
1/1/2025
Pharmacy Details
Pharmacy Name
FAMILY FARE PHARMACY #1524
Pharmacy Address
1204 N STATE ST
GLADWIN, MI 48624
Pharmacy Comments
Contract Details
Approval Date
10/7/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/13/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Bryan Rex Cross, President
(989) 839-1322
Contract Pharmacy Representative
SpartanNash
Eddie Garcia, Director of Pharmacy
(616) 878-2975
Signed By Date
10/7/2021
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