Contract Pharmacy Details

PERRY DRUG STORES, INC.
DSH230046 UNIVERSITY OF MICHIGAN HOSPITALS AND HEALTH CENTERS

Covered Entity Details

Entity Name

UNIVERSITY OF MICHIGAN HOSPITALS AND HEALTH CENTERS

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH230046

Entity Address

1500 EAST MEDICAL CENTER DRIVE
ANN ARBOR, MI 48109

Medicare Provider Number

230046

Participating Start Date

1/1/2004

Last Recertification Date

8/20/2024

Pharmacy Details

Pharmacy Name

PERRY DRUG STORES, INC.

Pharmacy Address

RITE AID #4350
3100 EAST MICHIGAN AVENUE
JACKSON, MI 49202

Pharmacy Comments

Contract Details

Approval Date

4/3/2018

Contract Begin Date

7/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

11/6/2023
Pharmacy closed

Contacts

Covered Entity Signing Official

Jeffrey S. Desmond, Chief Medical Officer
(734) 936-5814

Contract Pharmacy Representative

Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968

Signed By Date

4/3/2018

340B Drug Pricing Program Database