Contract Pharmacy Details

RITE AID OF MICHIGAN, INC.
DSH230066 Trinity Health Muskegon Hospital

Covered Entity Details

Entity Name

Trinity Health Muskegon Hospital

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH230066

Entity Address

1500 E. Sherman Blvd.
Muskegon, MI 49444

Medicare Provider Number

230066

Participating Start Date

1/1/2005

Last Recertification Date

9/6/2024

Pharmacy Details

Pharmacy Name

RITE AID OF MICHIGAN, INC.

Pharmacy Address

RITE AID #4977
2635 HENRY STREET
MUSKEGON, MI 49441

Pharmacy Comments

Contract Details

Approval Date

4/10/2017

Contract Begin Date

7/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

8/14/2024
Pharmacy closed

Contacts

Covered Entity Signing Official

Kristi Nagengast, Vice President of Finance
(231) 672-3802

Contract Pharmacy Representative

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

Signed By Date

4/10/2017

340B Drug Pricing Program Database