Contract Pharmacy Details

PERRY DRUG STORES, INC.
CH050360 Great Lakes Bay Health Centers

Covered Entity Details

Entity Name

Great Lakes Bay Health Centers

Subdivision Name

Great Lakes Bay Health Centers David R. Gamez

Type

HRSA-Funded Health Center

340B ID

CH050360

Entity Address

501 Lapeer Ave
Saginaw, MI 48607

Grant Number

H80CS00689

Participating Start Date

12/1/1992

Last Recertification Date

2/27/2025

Pharmacy Details

Pharmacy Name

PERRY DRUG STORES, INC.

Pharmacy Address

RITE AID #4502
211 E LAKE STREET
TAWAS CITY, MI 48763-9305

Pharmacy Comments

Contract Details

Approval Date

10/13/2023

Contract Begin Date

1/1/2024

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/4/2024
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Amy Colleen Evans, CFO
(989) 759-6438

Contract Pharmacy Representative

Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968

Signed By Date

10/13/2023

340B Drug Pricing Program Database