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ACCREDO HEALTH GROUP, INC.
RRC230216-00 MCLAREN PORT HURON
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Covered Entity Details
Entity Name
MCLAREN PORT HURON
Subdivision Name
Type
Rural Referral Center
340B ID
RRC230216-00
Entity Address
1221 PINE GROVE AVENUE
PORT HURON, MI 48060
Medicare Provider Number
230216
Participating Start Date
12/7/2021
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
ACCREDO HEALTH GROUP, INC.
Pharmacy Address
4750 E 450 S
SUITE A
WHITESTOWN, IN 46075
Pharmacy Comments
Contract Details
Approval Date
7/8/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kyle Vining, McLaren Port Huron CFO
(810) 989-3749
Contract Pharmacy Representative
Accredo Health Group, Inc.
Travis Behrens, Lead Director, 340B Client Sales
(407) 988-7044
Signed By Date
7/8/2024
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