Contract Pharmacy Details

RITE AID OF MICHIGAN, INC.
DSH230096 STURGIS HOSPITAL

Covered Entity Details

Entity Name

STURGIS HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH230096

Entity Address

916 MYRTLE AVENUE
STURGIS, MI 49091

Medicare Provider Number

230096

Participating Start Date

7/1/2011

Last Recertification Date

9/10/2018

Entity Termination Date

7/1/2019

Pharmacy Details

Pharmacy Name

RITE AID OF MICHIGAN, INC.

Pharmacy Address

RITE AID #4234
102 NORTH CENTERVILLE ROAD
STURGIS, MI 49091

Pharmacy Comments

Contract Details

Approval Date

1/6/2014

Contract Begin Date

4/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/1/2019
Covered Entity Terminated

Contacts

Covered Entity Signing Official

ROBERT J. LABARGE, CEO
(269) 659-4400

Contract Pharmacy Representative

Rite Aid
Tammy Royer, Group Vice President, Managed Care
(717) 730-8217

Signed By Date

1/6/2014

340B Drug Pricing Program Database