Contract Pharmacy Details

RITE AID OF MICHIGAN, INC.
DSH230015 THREE RIVERS HEALTH

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

RITE AID OF MICHIGAN, INC.

Pharmacy Address

RITE AID #4235
1113 WEST MICHIGAN AVENUE
THREE RIVERS, MI 49093

Pharmacy Comments

Contract Details

Approval Date

1/13/2016

Contract Begin Date

4/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/25/2024
Pharmacy closed

Contacts

Covered Entity Signing Official

STEVEN T. ANDREWS, CFO
(269) 273-9604

Contract Pharmacy Representative

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

Signed By Date

1/13/2016

340B Drug Pricing Program Database