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SUPERX DRUGS CORPORATION
CHC28352-00 ISABELLA CITIZENS FOR HEALTH, INC.
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Covered Entity Details
Entity Name
ISABELLA CITIZENS FOR HEALTH, INC.
Subdivision Name
Isabella Citizens for Health
Type
HRSA-Funded Health Center
340B ID
CHC28352-00
Entity Address
2940 Health Pkwy
Mount Pleasant, MI 48858-9342
Grant Number
H80CS28352
Participating Start Date
4/1/2016
Last Recertification Date
2/4/2019
Entity Termination Date
4/1/2020
Pharmacy Details
Pharmacy Name
SUPERX DRUGS CORPORATION
Pharmacy Address
DBA: THE KROGER CO OF MI #889
4080 E. BLUEGRASS
MT PLEASANT, MI 48858
Pharmacy Comments
Contract Details
Approval Date
7/17/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/2/2019
Pharmacy closed
Contacts
Covered Entity Signing Official
Jennifer White, Chief Executive Officer
(989) 953-5191 Ext: 1
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
7/17/2017
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