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RITE AID OF MICHIGAN, INC.
SCH230110-00 Corewell Health Ludington Hospital
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Covered Entity Details
Entity Name
Corewell Health Ludington Hospital
Subdivision Name
Ludington
Type
Sole Community Hospital
340B ID
SCH230110-00
Entity Address
1 N Atkinson Dr
Ludington, MI 49431
Medicare Provider Number
230110
Participating Start Date
1/1/2020
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
RITE AID OF MICHIGAN, INC.
Pharmacy Address
RITE AID #1524
924 WEST MAIN STREET
FREMONT, MI 49412
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
John Sella, Senior Director, Finance
(616) 643-9168
Contract Pharmacy Representative
Rite Aid
Charlene Kaiser, VP, Managed Care Operations
(918) 645-6652
Signed By Date
4/18/2022
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