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WAL-MART PHARMACY 10-2100
CAH231306-00 MACKINAC STRAITS HOSPITAL & HEALTH CENTER
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Covered Entity Details
Entity Name
MACKINAC STRAITS HOSPITAL & HEALTH CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH231306-00
Entity Address
1140 NORTH STATE STREET
SAINT IGNACE, MI 49781
Medicare Provider Number
231306
Participating Start Date
1/1/2011
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2100
Pharmacy Address
1150 SOUTH MAIN
CHEBOYGAN, MI 49721
Pharmacy Comments
Contract Details
Approval Date
4/3/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
JASON ANDERSON, CHIEF FINANCIAL OFFICER
(906) 643-0435
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
4/3/2014
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