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WAL-MART PHARMACY 10-5159
SCH230222-00 MYMICHIGAN MEDICAL CENTER MIDLAND
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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
WAL-MART PHARMACY 10-5159
Pharmacy Address
2750 COOK RD
WEST BRANCH, MI 48661
Pharmacy Comments
Contract Details
Approval Date
1/4/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/31/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Greg Harper Rogers, President
(989) 839-3225
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
1/4/2018
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