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Walmart Pharmacy 10-7611
SCH230222-00 MYMICHIGAN MEDICAL CENTER MIDLAND
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Covered Entity Details
Entity Name
MYMICHIGAN MEDICAL CENTER MIDLAND
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH230222-00
Entity Address
4000 WELLNESS DRIVE
MIDLAND, MI 48670
Medicare Provider Number
230222
Participating Start Date
7/1/2020
Last Recertification Date
8/19/2024
Entity Termination Date
1/1/2025
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
10/17/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Chuck Sherwin, President
(989) 794-7625
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/17/2023
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