Contract Pharmacy Details

PERRY DRUG STORES, INC.
DSH230046 UNIVERSITY OF MICHIGAN HOSPITALS AND HEALTH CENTERS

Covered Entity Details

Entity Name

UNIVERSITY OF MICHIGAN HOSPITALS AND HEALTH CENTERS

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH230046

Entity Address

1500 EAST MEDICAL CENTER DRIVE
ANN ARBOR, MI 48109

Medicare Provider Number

230046

Participating Start Date

1/1/2004

Last Recertification Date

8/20/2024

Pharmacy Details

Pharmacy Name

PERRY DRUG STORES, INC.

Pharmacy Address

RITE AID #4358
35101 MICHIGAN AVENUE EAST
WAYNE, MI 48184

Pharmacy Comments

Contract Details

Approval Date

10/16/2015

Contract Begin Date

1/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/16/2024
Pharmacy closed

Contacts

Covered Entity Signing Official

Tony Denton, COO
(734) 647-6623

Contract Pharmacy Representative

Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968

Signed By Date

10/16/2015

340B Drug Pricing Program Database