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ESI MAIL PHARMACY SERVICE
CHC08752-00 LAKELAND IMMEDIATE CARE CENTER
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Covered Entity Details
Entity Name
LAKELAND IMMEDIATE CARE CENTER
Subdivision Name
DBA CASS FAMILY CLINIC
Type
HRSA-Funded Health Center
340B ID
CHC08752-00
Entity Address
261 M-62
Cassopolis, MI 49031-1034
Grant Number
H80CS08752
Participating Start Date
4/1/2010
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
ESI MAIL PHARMACY SERVICE
Pharmacy Address
DBA EXPRESS SCRIPTS
7909 S HARDY DR STE 106
TEMPE, AZ 85284-1112
Pharmacy Comments
Contract Details
Approval Date
7/19/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Joseph Gavan, Chief Executive Officer
(269) 445-3874
Contract Pharmacy Representative
Express Scripts
Gene McCabe, 340B Lead Director
(615) 943-7500
Signed By Date
7/19/2024
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