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MEIJER STORES LIMITED PARTNERSHIP
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
MEIJER STORES LIMITED PARTNERSHIP
Pharmacy Address
D/B/A MEIJER PHARMACY #463
1515 PROFIT DR.
FORT WAYNE, IN 46808
Pharmacy Comments
Contract Details
Approval Date
4/10/2017
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
Meijer
Kevin Hurn, Dir, Pharmacy Procurement and New Business
(616) 791-5185
Signed By Date
4/10/2017
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