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THE KROGER CO OF MICHIGAN 887
DSH230167 MCLAREN GREATER LANSING
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Covered Entity Details
Entity Name
MCLAREN GREATER LANSING
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230167
Entity Address
2900 COLLINS RD.
LANSING, MI 48910
Medicare Provider Number
230167
Participating Start Date
4/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
THE KROGER CO OF MICHIGAN 887
Pharmacy Address
2495 N CEDAR ST
HOLT, MI 48842
Pharmacy Comments
Contract Details
Approval Date
7/15/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Dale Thompson, Chief Financial Officer
(517) 975-7555
Contract Pharmacy Representative
Kroger
Mike Puccini, New Business Development Manager
(513) 762-4672
Signed By Date
7/15/2016
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