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MYMICHIGAN MEDICAL CENTER MIDLAND
CAH231305-00 MYMICHIGAN MEDICAL CENTER STANDISH
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Covered Entity Details
Entity Name
MYMICHIGAN MEDICAL CENTER STANDISH
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH231305-00
Entity Address
805 W. CEDAR
STANDISH, MI 48658
Medicare Provider Number
231305
Participating Start Date
9/30/2010
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
MYMICHIGAN MEDICAL CENTER MIDLAND
Pharmacy Address
4000 WELLNESS DR
MIDLAND, MI 48670
Pharmacy Comments
Contract Details
Approval Date
10/15/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
michael joseph erickson, President
(989) 839-3378
Contract Pharmacy Representative
MyMichigan Health
Brooke Peterson, Manager, Pharmacy
(989) 596-9190
Signed By Date
10/15/2024
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