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MEIJER INC. #311
CH05203B CHERRY STREET SERVICES, INC.
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Covered Entity Details
Entity Name
CHERRY STREET SERVICES, INC.
Subdivision Name
BURTON HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH05203B
Entity Address
2135 Buchanan Ave SW
Grand Rapids, MI 49507-2911
Grant Number
H80CS00770
Participating Start Date
7/1/2002
Last Recertification Date
2/24/2025
Pharmacy Details
Pharmacy Name
MEIJER INC. #311
Pharmacy Address
1540 28TH STREET
GRAND RAPIDS, MI 49508
Pharmacy Comments
Contract Details
Approval Date
10/12/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tasha Blackmon, CEO
(616) 965-8215
Contract Pharmacy Representative
Meijer
Katy Diaz, Pharmacy Business Associate
(616) 791-3127
Signed By Date
10/12/2023
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