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FAMILY FARE PHARMACY #1517
CAH231322-00 MUNSON HEALTHCARE CHARLEVOIX HOSPITAL
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Covered Entity Details
Entity Name
MUNSON HEALTHCARE CHARLEVOIX HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH231322-00
Entity Address
14700 LAKE SHORE DRIVE
CHARLEVOIX, MI 49720-1931
Medicare Provider Number
231322
Participating Start Date
10/1/2012
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
FAMILY FARE PHARMACY #1517
Pharmacy Address
430 N. LAKE ST
BOYNE CITY, MI 49712
Pharmacy Comments
Contract Details
Approval Date
4/6/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lyn A. Jenks, CEO
(231) 547-8500
Contract Pharmacy Representative
Prevos Family Markets, Inc., Family Fare, LLC
Kristina Rooney, Pharmacy Contract Admin
(616) 878-2761
Signed By Date
4/6/2017
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