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WOODWARD DETROIT CVS, L.L.C.
RRC230022-00 COMMUNITY HEALTH CENTER BRANCH CTY
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Covered Entity Details
Entity Name
COMMUNITY HEALTH CENTER BRANCH CTY
Subdivision Name
Type
Rural Referral Center
340B ID
RRC230022-00
Entity Address
274 EAST CHICAGO STREET
COLDWATER, MI 49036
Medicare Provider Number
230022
Participating Start Date
7/1/2015
Last Recertification Date
11/16/2017
Entity Termination Date
4/1/2018
Pharmacy Details
Pharmacy Name
WOODWARD DETROIT CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 08126
61 W. PEARL ST.
COLDWATER, MI 49036
Pharmacy Comments
Contract Details
Approval Date
7/7/2015
Contract Begin Date
10/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2018
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Amy Crouch, CFO
(517) 279-5396
Contract Pharmacy Representative
CVS Caremark
JACKLYN PARFITT, MANAGER, PAYER RELATIONS
(401) 770-6467
Signed By Date
7/7/2015
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