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RITE AID OF MICHIGAN, INC.
SCH230058-00 MUNSON HEALTHCARE GRAYLING HOSPITAL
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Covered Entity Details
Entity Name
MUNSON HEALTHCARE GRAYLING HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH230058-00
Entity Address
1100 E Michigan Ave
GRAYLING, MI 49738
Medicare Provider Number
230058
Participating Start Date
4/1/2024
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
RITE AID OF MICHIGAN, INC.
Pharmacy Address
RITE AID #3320
425 N FIFTH STREET
PO BOX 732
ROSCOMMON, MI 48653
Pharmacy Comments
Contract Details
Approval Date
2/6/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/14/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
Kathleen M LaRaia, Vice President
(231) 392-8410
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968
Signed By Date
1/16/2024
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