Contract Pharmacy Details

FAMILY FARE PHARMACY
FQHC638522B NHBP Health Department

Covered Entity Details

Entity Name

NHBP Health Department

Subdivision Name

Type

Tribal Contract/Compact with IHS (P.L. 93-638)

340B ID

FQHC638522B

Entity Address

311 State Street
Grand Rapids, MI 49503

Grant Number

Participating Start Date

1/1/2017

Last Recertification Date

2/21/2025

Pharmacy Details

Pharmacy Name

FAMILY FARE PHARMACY

Pharmacy Address

6480 28TH AVENUE
HUDSONVILLE, MI 49426

Pharmacy Comments

Contract Details

Approval Date

10/14/2016

Contract Begin Date

1/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

6/15/2017
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Stephen W. Blann, Chief Financial Officer
(269) 729-5151 Ext: 8389

Contract Pharmacy Representative

SpartanNash
Eddie Garcia, Director of Pharmacy
(616) 878-2975

Signed By Date

10/14/2016

340B Drug Pricing Program Database