Contract Pharmacy Details

FBM DRUG COMPANY
DSH230070 COVENANT MEDICAL CENTER

Covered Entity Details

Entity Name

COVENANT MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH230070

Entity Address

1447 N HARRISON STREET
SAGINAW, MI 48602

Medicare Provider Number

230070

Participating Start Date

4/1/2004

Last Recertification Date

8/13/2024

Pharmacy Details

Pharmacy Name

FBM DRUG COMPANY

Pharmacy Address

DBA SATOW DRUG STORE
308 S MAIN ST
FRANKENMUTH, MI 48734

Pharmacy Comments

Contract Details

Approval Date

7/15/2013

Contract Begin Date

10/1/2013

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

5/2/2016
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

SPENCE MAIDLOW, CEO
(989) 583-6400

Contract Pharmacy Representative

Kenneth Boesnecker, CEO/Owner/RPh/President
(989) 652-8001

Signed By Date

7/15/2013

340B Drug Pricing Program Database