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APEX DRUG STORES, INC.
CAH231315-00 ASCENSION BORGESS-LEE HOSPITAL
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Covered Entity Details
Entity Name
ASCENSION BORGESS-LEE HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH231315-00
Entity Address
420 WEST HIGH STREET
DOWAGIAC, MI 49047
Medicare Provider Number
231315
Participating Start Date
9/30/2010
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
APEX DRUG STORES, INC.
Pharmacy Address
RITE AID #4401
102 STATE ROAD
DOWAGIAC, MI 49047
Pharmacy Comments
Contract Details
Approval Date
7/17/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/22/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
John Ryder, COO
(269) 783-3082
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968
Signed By Date
7/17/2017
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