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MEIJER STORES LIMITED PARTNERSHIP
CHC29011-00 PACKARD HEALTH, INC.
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Covered Entity Details
Entity Name
PACKARD HEALTH, INC.
Subdivision Name
Packard Health Carpenter
Type
HRSA-Funded Health Center
340B ID
CHC29011-00
Entity Address
2650 Carpenter Road
Ann Arbor, MI 48108
Grant Number
H80CS29011
Participating Start Date
4/1/2016
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
MEIJER STORES LIMITED PARTNERSHIP
Pharmacy Address
D/B/A MEIJER PHARMACY #463
1515 PROFIT DR.
FORT WAYNE, IN 46808
Pharmacy Comments
Contract Details
Approval Date
4/18/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mark Jacoby, CFO
(734) 971-1073
Contract Pharmacy Representative
Meijer
Jeff Romano, Hospital Programs
(616) 791-3171
Signed By Date
4/18/2016
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