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MEIJER STORES LIMITED PARTNERSHIP
SCH230239-00 MyMichigan Medical Center Sault
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Covered Entity Details
Entity Name
MyMichigan Medical Center Sault
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH230239-00
Entity Address
500 OSBORN BOULEVARD
SAULT STE. MARIE, MI 49783
Medicare Provider Number
230239
Participating Start Date
9/1/2010
Last Recertification Date
8/31/2024
Pharmacy Details
Pharmacy Name
MEIJER STORES LIMITED PARTNERSHIP
Pharmacy Address
D/B/A MEIJER PHARMACY #463
1515 PROFIT DR.
FORT WAYNE, IN 46808
Pharmacy Comments
Contract Details
Approval Date
4/19/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kevin Kalchik, President
(906) 635-4456
Contract Pharmacy Representative
Meijer
Katy Diaz, Pharmacy Business Associate
(616) 791-3127
Signed By Date
4/19/2023
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