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MUNSON HEALTHCARE SPECIALTY PHARMACY
CAH231301-00 KALKASKA MEMORIAL HEALTH CENTER
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Covered Entity Details
Entity Name
KALKASKA MEMORIAL HEALTH CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH231301-00
Entity Address
419 S. CORAL ST.
KALKASKA, MI 49646
Medicare Provider Number
231301
Participating Start Date
8/31/2010
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
MUNSON HEALTHCARE SPECIALTY PHARMACY
Pharmacy Address
550 MUNSON AVE UNIT 4
TRAVERSE CITY, MI 49686
Pharmacy Comments
Contract Details
Approval Date
7/14/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kevin Rogols, CEO
(231) 258-7501
Contract Pharmacy Representative
CPS/Munson Healthcare
Matthew Born, Specialty Pharmacy Manager
(231) 935-8736
Signed By Date
7/14/2023
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