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SUPER-X DRUGS CORPORATION
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
SUPER-X DRUGS CORPORATION
Pharmacy Address
DBA THE KROGER CO OF MICH#688
400 S. MAPLE ROAD
ANN ARBOR, MI 48103
Pharmacy Comments
Contract Details
Approval Date
7/18/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mark Jacoby, CFO
(734) 971-1073
Contract Pharmacy Representative
Kroger
Mike Puccini, New Business Development Manager
(513) 762-4672
Signed By Date
7/18/2016
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