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RITE AID OF MICHIGAN, INC.
CH050220 INTERCARE COMMUNITY HEALTH NETWORK
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Covered Entity Details
Entity Name
INTERCARE COMMUNITY HEALTH NETWORK
Subdivision Name
INTERCARE ADMINISTRATION
Type
HRSA-Funded Health Center
340B ID
CH050220
Entity Address
50 Industrial Park Rd
Bangor, MI 49013-1246
Grant Number
H80CS00771
Participating Start Date
7/1/1998
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
RITE AID OF MICHIGAN, INC.
Pharmacy Address
RITE AID #4237
715 EAST FRONT STREET
BUCHANAN, MI 49107
Pharmacy Comments
Contract Details
Approval Date
1/14/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/8/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
VELMA HENDERSHOTT, CEO
(269) 427-7937 Ext: 200
Contract Pharmacy Representative
Rite Aid
Tammy Royer, Group Vice President, Managed Care
(717) 730-8217
Signed By Date
1/14/2014
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