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WALGREEN CO.
CH05029J MIDMICHIGAN HEALTH SERVICES
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Covered Entity Details
Entity Name
MIDMICHIGAN HEALTH SERVICES
Subdivision Name
Northern Michigan Children's Assessment Center
Type
HRSA-Funded Health Center
340B ID
CH05029J
Entity Address
112 S 4th St Ste Medical
Roscommon, MI 48653-8904
Grant Number
H80CS00190
Participating Start Date
7/1/2024
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #11689
2045 S I75 BUSINESS LOOP
GRAYLING, MI 49738
Pharmacy Comments
Contract Details
Approval Date
4/18/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Melissa Jean Dunkle, CEO
(989) 422-2105 Ext: 2105
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/1/2024
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