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MEIJER DISTRIBUTION INC #90
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
MEIJER DISTRIBUTION INC #90
Pharmacy Address
2721 WALKER AVE NW
GRAND RAPIDS, MI 49544
Pharmacy Comments
Distribution Center
Contract Details
Approval Date
4/11/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/1/2017
Agreement registered in error
Contacts
Covered Entity Signing Official
Lyn A. Jenks, CEO
(231) 547-8500
Contract Pharmacy Representative
Meijer
Kevin Hurn, Dir, Pharmacy Procurement and New Business
(616) 791-5185
Signed By Date
4/11/2017
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