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RITE AID OF MICHIGAN, INC.
CH05029F MidMichigan Health Services
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Covered Entity Details
Entity Name
MidMichigan Health Services
Subdivision Name
Roscommon SBHC
Type
HRSA-Funded Health Center
340B ID
CH05029F
Entity Address
299H W Sunset Drive
Roscommon, MI 48653
Grant Number
H80CS00190
Participating Start Date
4/1/2013
Last Recertification Date
2/13/2025
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
4/2/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/13/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
Melissa Jean Dunkle, CEO
(989) 422-2105 Ext: 2105
Contract Pharmacy Representative
Rite-Aid
Charlene Kaiser, VP, Managed Care
(999) 999-9999
Signed By Date
4/2/2024
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