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TRINITY HEALTH-MICHIGAN
CH05102J HACKLEY COMMUNITY CARE CENTER INC
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Covered Entity Details
Entity Name
HACKLEY COMMUNITY CARE CENTER INC
Subdivision Name
Holton Elementary School
Type
HRSA-Funded Health Center
340B ID
CH05102J
Entity Address
6245 Syers Rd Ste A
Holton, MI 49425-7557
Grant Number
H80CS00684
Participating Start Date
1/1/2025
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
TRINITY HEALTH-MICHIGAN
Pharmacy Address
TRINITY HEALTH LONG TERM CARE PHARMACY-C
360 DIVISION AVE S STE 1C
GRAND RAPIDS, MI 49503
Pharmacy Comments
07/12/2013 - Undeleted per OPA Instructions and updated the pharmacy details. 06/17/2013 - Deleted duplicate for PharmacyID-15939 per OPA instructions.
Contract Details
Approval Date
10/9/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Valerie J Blondin, CFO
(231) 733-6657
Contract Pharmacy Representative
Mercy Health
Alan Goldman, Pharmacy Manager
(616) 685-1143
Signed By Date
10/9/2024
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