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RITE AID OF MICHIGAN, INC.
CAH231314-00 McKenzie Memorial Hospital
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Covered Entity Details
Entity Name
McKenzie Memorial Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH231314-00
Entity Address
120 Delaware Street
Sandusky, MI 48471
Medicare Provider Number
231314
Participating Start Date
7/1/2013
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
RITE AID OF MICHIGAN, INC.
Pharmacy Address
RITE AID #4228
39 KRISTIAN STREET
SANDUSKY, MI 48471
Pharmacy Comments
Contract Details
Approval Date
4/6/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/21/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
Amy Ruedisueli, CFO
(810) 648-6162
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968
Signed By Date
4/6/2017
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