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CENTRAL PHARMACY - MLK LLC
CH05183M INGHAM, COUNTY OF
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Covered Entity Details
Entity Name
INGHAM, COUNTY OF
Subdivision Name
Birch Community Health Center
Type
HRSA-Funded Health Center
340B ID
CH05183M
Entity Address
812 E Jolly Rd
Ste 112
Lansing, MI 48910-6818
Grant Number
H80CS00030
Participating Start Date
4/1/2017
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
CENTRAL PHARMACY - MLK LLC
Pharmacy Address
3500 S MARTIN LUTHER KING JR BLVD
LANSING, MI 48910-0333
Pharmacy Comments
Contract Details
Approval Date
10/15/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kris Drake, Executive Director/Deputy Health Officer
(517) 887-4361
Contract Pharmacy Representative
Allegan Pharmacy, LLC
Fadi Nuseibeh, Member
(313) 574-3434
Signed By Date
10/15/2023
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