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PERRY DRUG STORES, INC.
DSH230230 EDWARD W SPARROW HOSPITAL ASSOCIATION
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Covered Entity Details
Entity Name
EDWARD W SPARROW HOSPITAL ASSOCIATION
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230230
Entity Address
1215 E MICHIGAN AVE
LANSING, MI 48912
Medicare Provider Number
230230
Participating Start Date
10/1/2004
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
PERRY DRUG STORES, INC.
Pharmacy Address
RITE AID #4323
610 NORTH CEDAR ST STE A
MASON, MI 48854
Pharmacy Comments
Contract Details
Approval Date
4/15/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/21/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
PAULA M. REICHLE, SR VP AND CFO
(517) 364-5400
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President, Managed Care
(717) 975-5968
Signed By Date
4/15/2014
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