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PGPA PHARMACY
CH05022D INTERCARE COMMUNITY HEALTH NETWORK
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Covered Entity Details
Entity Name
INTERCARE COMMUNITY HEALTH NETWORK
Subdivision Name
INTERCARE BENTON HARBOR
Type
HRSA-Funded Health Center
340B ID
CH05022D
Entity Address
800 M-139
Benton Harbor, MI 49022
Grant Number
H80CS00771
Participating Start Date
7/1/1998
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
PGPA PHARMACY
Pharmacy Address
3544 MERIDIAN CROSSINGS
OKEMOS, MI 48864-6025
Pharmacy Comments
01/31/2013 addres line 1 update (was 3520 OKEMOS ROAD, SUITE 5)
Contract Details
Approval Date
3/8/2005
Contract Begin Date
3/8/2005
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2016
Agreement registered in error
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
3/8/2005
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