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WOODWARD DETROIT CVS, L.L.C.
DSH230030 MyMichigan Medical Center Alma
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Covered Entity Details
Entity Name
MyMichigan Medical Center Alma
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230030
Entity Address
300 EAST WARWICK DRIVE
ALMA, MI 48801
Medicare Provider Number
230030
Participating Start Date
4/1/2018
Last Recertification Date
8/25/2022
Entity Termination Date
10/1/2023
Pharmacy Details
Pharmacy Name
WOODWARD DETROIT CVS, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY # 10098
1306 S MISSION ST.
MOUNT PLEASANT, MI 48858
Pharmacy Comments
Contract Details
Approval Date
10/15/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Heather R Wager, Director of Finance
(989) 466-3281
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/15/2021
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