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THE KROGER CO MICHIGAN #782
CH053752B COVENANT COMMUNITY CARE, INC.
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Covered Entity Details
Entity Name
COVENANT COMMUNITY CARE, INC.
Subdivision Name
Covenant Woodward Avenue
Type
HRSA-Funded Health Center
340B ID
CH053752B
Entity Address
27776 Woodward Ave
Royal Oak, MI 48067-0970
Grant Number
H80CS08738
Participating Start Date
10/1/2010
Last Recertification Date
2/7/2023
Entity Termination Date
4/1/2024
Pharmacy Details
Pharmacy Name
THE KROGER CO MICHIGAN #782
Pharmacy Address
30991 N WOODWARD AVENUE
ROYAL OAK, MI 48073
Pharmacy Comments
Contract Details
Approval Date
3/9/2011
Contract Begin Date
3/10/2011
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/30/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
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