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D&W PHARMACY #1903
CH05183Q COUNTY OF INGHAM
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Covered Entity Details
Entity Name
COUNTY OF INGHAM
Subdivision Name
East Lansing Community Health Center
Type
HRSA-Funded Health Center
340B ID
CH05183Q
Entity Address
509 Burcham Dr
East Lansing, MI 48823-2750
Grant Number
H80CS00030
Participating Start Date
4/1/2024
Last Recertification Date
Entity Termination Date
1/1/2025
Pharmacy Details
Pharmacy Name
D&W PHARMACY #1903
Pharmacy Address
151 WEST GRAND RIVER
WILLIAMSTON, MI 48895-1317
Pharmacy Comments
Contract Details
Approval Date
7/11/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Kris Drake, Executive Director/Deputy Health Officer
(517) 887-4361
Contract Pharmacy Representative
Family Fare
Amy Ellis, Director of Pharmacy
(616) 878-2975
Signed By Date
7/11/2024
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