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MEIJER INC #163
RRC230216-00 MCLAREN PORT HURON
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Covered Entity Details
Entity Name
MCLAREN PORT HURON
Subdivision Name
Type
Rural Referral Center
340B ID
RRC230216-00
Entity Address
1221 PINE GROVE AVENUE
PORT HURON, MI 48060
Medicare Provider Number
230216
Participating Start Date
12/7/2021
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
MEIJER INC #163
Pharmacy Address
4775 24TH AVENUE
FORT GRATIOT, MI 48059
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
Sharelle Brown, Corporate, 340B Program Director
(248) 396-8085
Contract Pharmacy Representative
Meijer
Kevin Hurn, Dir, Pharmacy Procurement and New Business
(616) 791-5185
Signed By Date
1/13/2023
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