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PERRY DRUG STORES, INC.
DSH230121 The Memorial Hospital d/b/a Memorial Healthcare
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Covered Entity Details
Entity Name
The Memorial Hospital d/b/a Memorial Healthcare
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230121
Entity Address
826 W. King Street
Owosso, MI 48867
Medicare Provider Number
230121
Participating Start Date
7/1/2014
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
PERRY DRUG STORES, INC.
Pharmacy Address
RITE AID #4440
9090 MILLER ROAD
SWARTZ CREEK, MI 48473
Pharmacy Comments
Contract Details
Approval Date
10/17/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/22/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
Jorri Tremain, Chief Financial Officer
(989) 729-4466
Contract Pharmacy Representative
Rite Aid
Christopher Moen, Vice President
(210) 587-3486 Ext: 354
Signed By Date
10/17/2022
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