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MODERN MEDICAL SERVICE, INC.
SCH230133-00 MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH230133-00
Entity Address
825 N. CENTER AVENUE
GAYLORD, MI 49735
Medicare Provider Number
230133
Participating Start Date
8/11/2010
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
MODERN MEDICAL SERVICE, INC.
Pharmacy Address
DBA MODERN PHARMACY
127 N MAIN ST
PO BOX 345
CHEBOYGAN, MI 49721
Pharmacy Comments
Contract Details
Approval Date
1/13/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kathleen Maly Maly, Interim Chief Financial Officer
(248) 885-1252
Contract Pharmacy Representative
Modern Medical Services, Inc.
Travis Woiderski, General Manager
(231) 627-9949
Signed By Date
1/13/2023
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