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MYMICHIGAN MEDICAL CENTER MIDLAND
CAH231325-00 MyMichigan Medical Center Gladwin
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Covered Entity Details
Entity Name
MyMichigan Medical Center Gladwin
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH231325-00
Entity Address
515 QUARTER STREET
GLADWIN, MI 48624
Medicare Provider Number
231325
Participating Start Date
8/31/2010
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
MYMICHIGAN MEDICAL CENTER MIDLAND
Pharmacy Address
4000 WELLNESS DR
MIDLAND, MI 48670
Pharmacy Comments
Contract Details
Approval Date
10/5/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ray Stover, Regional President
(989) 246-6203
Contract Pharmacy Representative
MyMichigan Health
Brooke Peterson, Manager, Pharmacy
(989) 596-9190
Signed By Date
10/5/2023
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