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RITE AID OF MICHIGAN, INC.
DSH230121 The Memorial Hospital d/b/a Memorial Healthcare
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Covered Entity Details
Entity Name
The Memorial Hospital d/b/a Memorial Healthcare
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230121
Entity Address
826 W. King Street
Owosso, MI 48867
Medicare Provider Number
230121
Participating Start Date
7/1/2014
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
RITE AID OF MICHIGAN, INC.
Pharmacy Address
RITE AID #3312
8531 LANSING HIGHWAY
DURAND, MI 48429
Pharmacy Comments
Contract Details
Approval Date
4/13/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/22/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
Tim Susterich, Chief Operating Officer and Chief Financial Officer
(989) 725-4824
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President Managed Care
(717) 975-5978
Signed By Date
4/13/2016
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