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FAMILY FARE PHARMACY
FQHC638522 NHBP HEALTH DEPARTMENT
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Covered Entity Details
Entity Name
NHBP HEALTH DEPARTMENT
Subdivision Name
Type
Tribal Contract/Compact with IHS (P.L. 93-638)
340B ID
FQHC638522
Entity Address
1474 Mno-Bmadzewen Way
Fulton, MI 49052
Grant Number
Participating Start Date
1/1/2009
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
FAMILY FARE PHARMACY
Pharmacy Address
6480 28TH AVENUE
HUDSONVILLE, MI 49426
Pharmacy Comments
Contract Details
Approval Date
7/15/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/15/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Stephen W. Blann, Chief Financial Officer
(269) 729-5151 Ext: 8389
Contract Pharmacy Representative
Eddie Garcia, Director of Pharmacy
(616) 878-2975
Signed By Date
7/15/2016
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