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MYMICHIGAN HOME CARE
DSH230036 MyMichigan Medical Center Alpena
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Covered Entity Details
Entity Name
MyMichigan Medical Center Alpena
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230036
Entity Address
1501 W. CHISHOLM
ALPENA, MI 49707
Medicare Provider Number
230036
Participating Start Date
7/1/2019
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
MYMICHIGAN HOME CARE
Pharmacy Address
4500 N CAMPUS RIDGE DR
MIDLAND, MI 48640
Pharmacy Comments
Contract Details
Approval Date
1/16/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
michael joseph erickson, President
(989) 839-3378
Contract Pharmacy Representative
MidMichigan Health System
Kenneth P Spencer, Manager Pharmacy Informatics
(989) 839-1522
Signed By Date
1/16/2024
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