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PDS-I MICHIGAN, INC.
CH05036AV 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 TRI-CAP
Type
HRSA-Funded Health Center
340B ID
CH05036AV
Entity Address
2300 Veterans Memorial Pkwy
Saginaw, MI 48601
Grant Number
H80CS00689
Participating Start Date
4/23/2020
Last Recertification Date
2/28/2025
Pharmacy Details
Pharmacy Name
PDS-I MICHIGAN, INC.
Pharmacy Address
RITE AID #4564
531 WEST GENESEE AVENUE
SAGINAW, MI 48602
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
12/13/2023
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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