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WAL-MART PHARMACY 10-2014
CH05029E MIDMICHIGAN HEALTH SERVICES, INC
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Covered Entity Details
Entity Name
MIDMICHIGAN HEALTH SERVICES, INC
Subdivision Name
HOUGHTON LAKE SBHC
Type
HRSA-Funded Health Center
340B ID
CH05029E
Entity Address
4433 W Houghton Lake Dr
Houghton Lake, MI 48629-9786
Grant Number
H80CS00190
Participating Start Date
4/1/2013
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2014
Pharmacy Address
2129 WEST HOUGHTON LAKE DRIVE
HOUGHTON LAKE, MI 48629
Pharmacy Comments
Contract Details
Approval Date
4/2/2024
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
Walmart
Julie Howard, 340b Program Manager
(479) 739-1973 Ext: 4792771498
Signed By Date
4/2/2024
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