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RITE AID OF MICHIGAN, INC.
DSH230059 SAINT MARY'S HEALTH CARE
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Covered Entity Details
Entity Name
SAINT MARY'S HEALTH CARE
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230059
Entity Address
200 JEFFERSON SE
GRAND RAPIDS, MI 49503
Medicare Provider Number
230059
Participating Start Date
12/1/2005
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
RITE AID OF MICHIGAN, INC.
Pharmacy Address
RITE AID #2776
603 EAST SAVIDGE STREET
SPRING LAKE, MI 49456
Pharmacy Comments
Contract Details
Approval Date
4/16/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
Daniel G. Green, Vice President for Finance
(616) 685-6709
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968
Signed By Date
4/16/2018
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