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MEIJER INC #19
CH05102N HACKLEY COMMUNITY CARE CENTER INC
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Covered Entity Details
Entity Name
HACKLEY COMMUNITY CARE CENTER INC
Subdivision Name
Charles Hackley Middle School
Type
HRSA-Funded Health Center
340B ID
CH05102N
Entity Address
180 E. Laketon Ave STE A
Muskegon, MI 49442
Grant Number
H80CS00684
Participating Start Date
1/1/2025
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
MEIJER INC #19
Pharmacy Address
700 WEST NORTON AVENUE
MUSKEGON, MI 49441
Pharmacy Comments
Contract Details
Approval Date
12/3/2024
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
Meijer
Katy Diaz, Pharmacy Business Associate
(616) 791-3127
Signed By Date
12/3/2024
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