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MEIJER INC #19
CH05102F HACKLEY COMMUNITY CARE CENTER INC
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Covered Entity Details
Entity Name
HACKLEY COMMUNITY CARE CENTER INC
Subdivision Name
Hackley Community Care Forest Site
Type
HRSA-Funded Health Center
340B ID
CH05102F
Entity Address
172 E Forest Ave
Muskegon, MI 49442-5519
Grant Number
H80CS00684
Participating Start Date
1/1/2023
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
MEIJER INC #19
Pharmacy Address
700 WEST NORTON AVENUE
MUSKEGON, MI 49441
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
Valerie J Blondin, CFO
(231) 733-6657
Contract Pharmacy Representative
Meijer
Katy Diaz, Pharmacy Business Associate
(616) 791-3127
Signed By Date
10/12/2023
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