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WAL-MART PHARMACY 10-1422
RRC230080-00 McLaren Central Michigan
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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
WAL-MART PHARMACY 10-1422
Pharmacy Address
7700 N ALGER RD
ALMA, MI 48801
Pharmacy Comments
Contract Details
Approval Date
10/20/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
William P. Lawrence, President and CEO
(989) 772-6730
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
10/20/2014
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