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WAL-MART PHARMACY 10-1790
CH052910 FAMILY MEDICAL CENTER OF MICHIGAN INC
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Covered Entity Details
Entity Name
FAMILY MEDICAL CENTER OF MICHIGAN INC
Subdivision Name
FAMILY MEDICAL CENTER OF MI, INC
Type
HRSA-Funded Health Center
340B ID
CH052910
Entity Address
8765 Lewis Ave
Temperance, MI 48182-9583
Grant Number
H80CS00390
Participating Start Date
10/1/2001
Last Recertification Date
3/6/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1790
Pharmacy Address
2150 N TELEGRAPH RD
MONROE, MI 48162
Pharmacy Comments
Contract Details
Approval Date
10/14/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ED LARKINS, CEO
(734) 847-3802 Ext: 1412
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
10/14/2021
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