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SWANSTRA PHARMACY
CH050220 INTERCARE COMMUNITY HEALTH NETWORK
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Covered Entity Details
Entity Name
INTERCARE COMMUNITY HEALTH NETWORK
Subdivision Name
INTERCARE ADMINISTRATION
Type
HRSA-Funded Health Center
340B ID
CH050220
Entity Address
50 Industrial Park Rd
Bangor, MI 49013-1246
Grant Number
H80CS00771
Participating Start Date
7/1/1998
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
SWANSTRA PHARMACY
Pharmacy Address
(REMOTE PHARMACY)
3 W MONROE ST
BANGOR, MI 49013
Pharmacy Comments
Contract Details
Approval Date
1/16/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/29/2024
Agreement registered in error
Contacts
Covered Entity Signing Official
VELMA HENDERSHOTT, CEO
(269) 427-7937 Ext: 200
Contract Pharmacy Representative
HOMETOWN PHARMACY
Rebekah DesArmo, Vice President - Finance
(269) 427-7706
Signed By Date
1/16/2024
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