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MYMICHIGAN MEDICAL CENTER ALMA
SCH230036-00 MidMichigan Medical Center-Alpena
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Covered Entity Details
Entity Name
MidMichigan Medical Center-Alpena
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH230036-00
Entity Address
1501 W. CHISHOLM
ALPENA, MI 49707
Medicare Provider Number
230036
Participating Start Date
10/1/2018
Last Recertification Date
11/9/2017
Entity Termination Date
7/1/2019
Pharmacy Details
Pharmacy Name
MYMICHIGAN MEDICAL CENTER ALMA
Pharmacy Address
300 E WARWICK DR
ALMA, MI 48801
Pharmacy Comments
Contract Details
Approval Date
4/7/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2018
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Karmon Bjella, President
(989) 356-7245
Contract Pharmacy Representative
MidMichigan Health
Bryan Rex Cross, President
(989) 839-1322
Signed By Date
4/7/2017
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