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REVERENCE HOME HEALTH AND HOSPICE LLC
SCH230100-00 MYMICHIGAN MEDICAL CENTER TAWAS
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Covered Entity Details
Entity Name
MYMICHIGAN MEDICAL CENTER TAWAS
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH230100-00
Entity Address
200 Hemlock Road/ M-55
Tawas City, MI 48763
Medicare Provider Number
230100
Participating Start Date
7/1/2012
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
REVERENCE HOME HEALTH AND HOSPICE LLC
Pharmacy Address
DBA COMPASSUS
28120 DEQUINDRE RD
WARREN, MI 48092
Pharmacy Comments
Contract Details
Approval Date
4/17/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Sharon K Leaman-Case, VP Operations
(989) 907-7678
Contract Pharmacy Representative
COMPASSUS
KRISTEN FANO-SCHULTZE, VICE PRESIDENT OF HOME INFUSION
(803) 391-0674
Signed By Date
4/17/2023
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