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SEROSEDSERIO LLC
SCH230100-00 MYMICHIGAN MEDICAL CENTER TAWAS
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Covered Entity Details
Entity Name
MYMICHIGAN MEDICAL CENTER TAWAS
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH230100-00
Entity Address
200 Hemlock Road/ M-55
Tawas City, MI 48763
Medicare Provider Number
230100
Participating Start Date
7/1/2012
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
SEROSEDSERIO LLC
Pharmacy Address
DBA SAV-MOR SUPER DRUGS-TAWAS
306 W LAKE ST
TAWAS CITY, MI 48763-8308
Pharmacy Comments
Contract Details
Approval Date
7/13/2015
Contract Begin Date
10/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/16/2015
Agreement registered in error
Contacts
Covered Entity Signing Official
Ann M. Balfour, Chief Administrative Officer
(989) 362-9301
Contract Pharmacy Representative
Scott Somerfield, Pharmacy Manager
(989) 362-3311
Signed By Date
7/13/2015
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