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The Q2 2025 registration window for covered entities is open from 4/1/2025 - 4/15/2025.
PINE KNOB PHARMACY #3 INC
DSH230207 McLaren Oakland
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Covered Entity Details
Entity Name
McLaren Oakland
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230207
Entity Address
50 NORTH PERRY
PONTIAC, MI 48342
Medicare Provider Number
230207
Participating Start Date
1/1/2005
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
PINE KNOB PHARMACY #3 INC
Pharmacy Address
6770 DIXIE HWY
CLARKSTON, MI 48346-2087
Pharmacy Comments
Contract Details
Approval Date
7/7/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/1/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Matthew LeGault, CFO
(248) 338-5691
Contract Pharmacy Representative
Sav-Mor Pharmacy Services
Yvonne Gallagher, President
(248) 305-7654
Signed By Date
7/7/2016
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