Contract Pharmacy Details

RITE AID OF MICHIGAN, INC.
DSH230236 METROPOLITAN HOSPITAL

Covered Entity Details

Entity Name

METROPOLITAN HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH230236

Entity Address

5900 BYRON CENTER AVE SW
WYOMING, MI 49519

Medicare Provider Number

230236

Participating Start Date

7/1/2004

Last Recertification Date

8/19/2024

Pharmacy Details

Pharmacy Name

RITE AID OF MICHIGAN, INC.

Pharmacy Address

RITE AID #1532
9377 CHERRY VALLEY ROAD
CALEDONIA, MI 49316

Pharmacy Comments

Contract Details

Approval Date

1/14/2016

Contract Begin Date

4/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

8/5/2024
Pharmacy closed

Contacts

Covered Entity Signing Official

MICHAEL D. FAAS, CEO
(616) 252-4788

Contract Pharmacy Representative

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

Signed By Date

1/14/2016

340B Drug Pricing Program Database