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WALGREEN CO
CH05029C MIDMICHIGAN HEALTH SERVICES, INC
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Covered Entity Details
Entity Name
MIDMICHIGAN HEALTH SERVICES, INC
Subdivision Name
MIDMICHIGAN MEDICAL OFFICES - ROSCOMMON
Type
HRSA-Funded Health Center
340B ID
CH05029C
Entity Address
135 Lake St
Roscommon, MI 48653-7658
Grant Number
H80CS00190
Participating Start Date
1/1/2004
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO
Pharmacy Address
DBA: WALGREENS #10489
729 W HOUGHTON LAKE DR
PRUDENVILLE, MI 48651-8425
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
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/2/2024
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