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PERRY DRUG STORES, INC.
SCH230093-00 Corewell Health Big Rapids Hospital
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Covered Entity Details
Entity Name
Corewell Health Big Rapids Hospital
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH230093-00
Entity Address
605 Oak Street
Big Rapids, MI 49307-2048
Medicare Provider Number
230093
Participating Start Date
1/1/2014
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
PERRY DRUG STORES, INC.
Pharmacy Address
RITE AID #4506
720 SOUTH MITCHELL STREET
CADILLAC, MI 49601
Pharmacy Comments
Contract Details
Approval Date
4/18/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/22/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Tom Knoerl, Controller
(231) 592-4253
Contract Pharmacy Representative
Rite Aid
Charlene Kaiser, VP, Managed Care Operations
(918) 645-6652
Signed By Date
4/18/2022
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