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PERRY DRUG STORES, INC.
FQHCLA313A OAKLAND INTEGRATED HEALTHCARE NETWORK
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Covered Entity Details
Entity Name
OAKLAND INTEGRATED HEALTHCARE NETWORK
Subdivision Name
OIHN Summit Center
Type
Health Center Program Look-Alike
340B ID
FQHCLA313A
Entity Address
279 Summit Dr
Waterford, MI 48328-3364
Grant Number
LALCS00140
Participating Start Date
4/1/2016
Last Recertification Date
2/9/2017
Entity Termination Date
7/1/2017
Pharmacy Details
Pharmacy Name
PERRY DRUG STORES, INC.
Pharmacy Address
RITE AID #4302
1186 BALDWIN AVENUE
PONTIAC, MI 48340
Pharmacy Comments
Contract Details
Approval Date
7/20/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2017
Contacts
Covered Entity Signing Official
Debbie Brinson, CEO
(248) 724-7438
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968
Signed By Date
7/20/2016
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