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MUNSON SERVICES INC
FQHC638527 Grand Traverse Band of Ottawa and Chiippewa Indians
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Covered Entity Details
Entity Name
Grand Traverse Band of Ottawa and Chiippewa Indians
Subdivision Name
Grand Traverse Band Family Health Clinic
Type
Tribal Contract/Compact with IHS (P.L. 93-638)
340B ID
FQHC638527
Entity Address
2300 N Stallman Rd
Peshawbestown, MI 49682
Grant Number
Participating Start Date
10/1/2012
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
MUNSON SERVICES INC
Pharmacy Address
DBA MUNSON COMMUNITY HEALTH CENTER PHAR
550 MUNSON AVE # G100
G100
TRAVERSE CITY, MI 49686-3580
Pharmacy Comments
Contract Details
Approval Date
2/21/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/20/2025
Ownership change
Contacts
Covered Entity Signing Official
Loi Chambers, Assistant Health Administrator
(231) 534-7477
Contract Pharmacy Representative
Munson Medical Center Thomas Judd
Chris Podges, Chief Information Officer
(231) 935-6548
Signed By Date
1/15/2013
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