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RITE AID OF MICHIGAN, INC.
DSH230132 HURLEY MEDICAL CENTER
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Covered Entity Details
Entity Name
HURLEY MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230132
Entity Address
ONE HURLEY PLAZA
FLINT, MI 48503
Medicare Provider Number
230132
Participating Start Date
12/1/1992
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
RITE AID OF MICHIGAN, INC.
Pharmacy Address
RITE AID #1587
4519 RICHFIELD ROAD
FLINT, MI 48506
Pharmacy Comments
Contract Details
Approval Date
10/15/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/15/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Melany Gavulic, President & CEO
(810) 262-6887
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968
Signed By Date
10/15/2015
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