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FRED SUPERMKT/PHCY-3 RIVER INC
DSH230015 THREE RIVERS HEALTH
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Covered Entity Details
Entity Name
THREE RIVERS HEALTH
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230015
Entity Address
701 S. HEALTH PARKWAY
THREE RIVERS, MI 49093
Medicare Provider Number
230015
Participating Start Date
10/1/2011
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
FRED SUPERMKT/PHCY-3 RIVER INC
Pharmacy Address
FRED'S SUPERMARKET AND PHARMACY
808 W MICHIGAN AVE
THREE RIVERS, MI 49093-3103
Pharmacy Comments
Contract Details
Approval Date
10/10/2013
Contract Begin Date
1/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
STEVEN T. ANDREWS, CFO
(269) 273-9604
Contract Pharmacy Representative
Sheroyl Kirby, Manager/VP
(269) 278-2355
Signed By Date
10/10/2013
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