340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
SAI RX MART LLC
CAH231325-00 MyMichigan Medical Center Gladwin
Print
Covered Entity Details
Entity Name
MyMichigan Medical Center Gladwin
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH231325-00
Entity Address
515 QUARTER STREET
GLADWIN, MI 48624
Medicare Provider Number
231325
Participating Start Date
8/31/2010
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
SAI RX MART LLC
Pharmacy Address
DBA THE MEDICINE SHOPPE
663 E CEDAR AVE
DBA THE MEDICINE SHOPPE
GLADWIN, MI 48624
Pharmacy Comments
Contract Details
Approval Date
10/1/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/15/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Ray Stover, Regional President
(989) 246-6203
Contract Pharmacy Representative
Andrea Muma, Representative
(989) 426-4595
Signed By Date
10/1/2014
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session