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RITE AID OF MICHIGAN, INC.
DSH230035 Corewell Health Greenville Hospital
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Covered Entity Details
Entity Name
Corewell Health Greenville Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230035
Entity Address
615 S. BOWER STREET
GREENVILLE, MI 48838
Medicare Provider Number
230035
Participating Start Date
1/20/2010
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
RITE AID OF MICHIGAN, INC.
Pharmacy Address
RITE AID #1528
10767 E CARSON CITY ROAD
CARSON CITY, MI 48811
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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