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MEIJER STORES LIMITED PARTNERSHIP
CAH231312-00 SHERIDAN COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
SHERIDAN COMMUNITY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH231312-00
Entity Address
301 N MAIN STREET
SHERIDAN, MI 48884
Medicare Provider Number
231312
Participating Start Date
7/1/2017
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
MEIJER STORES LIMITED PARTNERSHIP
Pharmacy Address
D/B/A MEIJER PHARMACY #463
1515 PROFIT DR.
FORT WAYNE, IN 46808
Pharmacy Comments
Contract Details
Approval Date
10/12/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Randolph K. Flechsig, CEO
(989) 291-6300
Contract Pharmacy Representative
Meijer
Kevin Hurn, Dir, Pharmacy Procurement and New Business
(616) 791-5185
Signed By Date
10/12/2017
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