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SHOPKO PHARMACY #2010
CHC26511-07 UPPER GREAT LAKES FAMILY HEALTH CENTER
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Covered Entity Details
Entity Name
UPPER GREAT LAKES FAMILY HEALTH CENTER
Subdivision Name
Lake Linden Family Health Center
Type
HRSA-Funded Health Center
340B ID
CHC26511-07
Entity Address
945 9TH ST
LAKE LINDEN, MI 49945
Grant Number
H80CS26511
Participating Start Date
7/1/2014
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
SHOPKO PHARMACY #2010
Pharmacy Address
1150 W. WASHINGTON
MARQUETTE, MI 49855-4099
Pharmacy Comments
Contract Details
Approval Date
6/18/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/28/2019
Pharmacy closed
Contacts
Covered Entity Signing Official
Donald A. Simila, CEO
(906) 481-8571
Contract Pharmacy Representative
Shopko
Tad Schilke, Director of Rx Merchandising & Marketing
(920) 429-7628
Signed By Date
6/18/2014
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