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WAL-MART PHARMACY 10-2014
CH050290 MIDMICHIGAN HEALTH SERVICES, INC
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Covered Entity Details
Entity Name
MIDMICHIGAN HEALTH SERVICES, INC
Subdivision Name
MIDMICHIGAN HEALTH PARK - HOUGHTON LAKE
Type
HRSA-Funded Health Center
340B ID
CH050290
Entity Address
9249 W Lake City RD
Houghton Lake, MI 48629-9602
Grant Number
H80CS00190
Participating Start Date
1/1/2004
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2014
Pharmacy Address
2129 WEST HOUGHTON LAKE DRIVE
HOUGHTON LAKE, MI 48629
Pharmacy Comments
Contract Details
Approval Date
4/16/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jim Raschke, Executive Director
(989) 422-2105
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/16/2018
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