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APOTHECARY - HOUGHTON
CHC26511-02 UPPER GREAT LAKES FAMILY HEALTH CENTER
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Covered Entity Details
Entity Name
UPPER GREAT LAKES FAMILY HEALTH CENTER
Subdivision Name
Calumet Family Health Center
Type
HRSA-Funded Health Center
340B ID
CHC26511-02
Entity Address
56901 South Sixth Street, Suites 1 and 2
Calumet, MI 49913-2946
Grant Number
H80CS26511
Participating Start Date
4/1/2014
Last Recertification Date
2/2/2017
Entity Termination Date
4/1/2017
Pharmacy Details
Pharmacy Name
APOTHECARY - HOUGHTON
Pharmacy Address
600 MACINNES DR
HOUGHTON, MI 49931-1144
Pharmacy Comments
Contract Details
Approval Date
4/15/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2017
Contacts
Covered Entity Signing Official
Donald A. Simila, CEO
(906) 481-8571
Contract Pharmacy Representative
Portage Health
Jason Evans, Director
(906) 483-1905
Signed By Date
4/15/2014
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