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PERRY DRUG STORES, INC.
CH05036AW Great Lakes Bay Health Centers
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Covered Entity Details
Entity Name
Great Lakes Bay Health Centers
Subdivision Name
Great Lakes Bay Health Centers Bridgeport Spaulding High School
Type
HRSA-Funded Health Center
340B ID
CH05036AW
Entity Address
4691 Bearcat Blvd Fl 1
Bridgeport, MI 48722
Grant Number
H80CS00689
Participating Start Date
7/1/2020
Last Recertification Date
2/27/2025
Pharmacy Details
Pharmacy Name
PERRY DRUG STORES, INC.
Pharmacy Address
RITE AID #4357
3880 WILDER ROAD
BAY CITY, MI 48706
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
8/22/2024
Pharmacy closed
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
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