Contract Pharmacy Details

MEIJER DISTRIBUTION INC #90
RRC230080-00 McLaren Central Michigan

Covered Entity Details

Entity Name

McLaren Central Michigan

Subdivision Name

Type

Rural Referral Center

340B ID

RRC230080-00

Entity Address

1221 South Drive
Mount Pleasant, MI 48858

Medicare Provider Number

230080

Participating Start Date

10/1/2012

Last Recertification Date

9/3/2020

Entity Termination Date

10/1/2021

Pharmacy Details

Pharmacy Name

MEIJER DISTRIBUTION INC #90

Pharmacy Address

2721 WALKER AVE NW
GRAND RAPIDS, MI 49544

Pharmacy Comments

Distribution Center

Contract Details

Approval Date

1/15/2014

Contract Begin Date

4/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/1/2021
Covered Entity Terminated

Contacts

Covered Entity Signing Official

William P. Lawrence, President and CEO
(989) 772-6730

Contract Pharmacy Representative

Meijer
Jeff Romano, Hospital Programs
(616) 791-3171

Signed By Date

1/15/2014

340B Drug Pricing Program Database