Contract Pharmacy Details

MYMICHIGAN MEDICAL CENTER MIDLAND
SCH230222-00 MYMICHIGAN MEDICAL CENTER MIDLAND

Covered Entity Details

Entity Name

MYMICHIGAN MEDICAL CENTER MIDLAND

Subdivision Name

Type

Sole Community Hospital

340B ID

SCH230222-00

Entity Address

4000 WELLNESS DRIVE
MIDLAND, MI 48670

Medicare Provider Number

230222

Participating Start Date

7/1/2020

Last Recertification Date

8/19/2024

Entity Termination Date

1/1/2025

Pharmacy Details

Pharmacy Name

MYMICHIGAN MEDICAL CENTER MIDLAND

Pharmacy Address

DBA MYMICHIGAN MEDICAL CENTER MT. PLEASA
4851 E PICKARD ST
MOUNT PLEASANT, MI 48858

Pharmacy Comments

Contract Details

Approval Date

10/31/2017

Contract Begin Date

1/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/1/2018
Ownership change

Contacts

Covered Entity Signing Official

Greg Harper Rogers, President
(989) 839-3225

Contract Pharmacy Representative

MidMichigan Health
Bryan Rex Cross, President
(989) 839-1322

Signed By Date

10/13/2017

340B Drug Pricing Program Database