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MUNSON HOSPITAL PHARMACY
CAH231300-00 PAUL OLIVER MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
PAUL OLIVER MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH231300-00
Entity Address
224 PARK AVENUE
FRANKFORT, MI 49635
Medicare Provider Number
231300
Participating Start Date
9/20/2010
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
MUNSON HOSPITAL PHARMACY
Pharmacy Address
1105 SIXTH ST
TRAVERSE CITY, MI 49684
Pharmacy Comments
Contract Details
Approval Date
10/17/2012
Contract Begin Date
10/17/2012
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
PETER MARINOFF, CHIEF OPERATING OFFICER
(231) 352-2259
Contract Pharmacy Representative
Edwin Ness, President and CEO
(231) 935-6910
Signed By Date
9/20/2012
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