Contract Notice Template - Michigan



Form No. DMB 234A (Rev. 1/96)

AUTHORITY: Act 431 of 1984

COMPLETION: Required

PENALTY: Failure to deliver in accordance with Contract

terms and conditions and this notice,may be considered

in default of Contract

STATE OF MICHIGAN

DEPARTMENT OF MANAGEMENT AND BUDGET February 24, 2005

ACQUISITION SERVICES

P.O. BOX 30026, LANSING, MI 48909

OR

530 W. ALLEGAN, LANSING, MI 48933

NOTICE

OF

CONTRACT NO. 071B4200237  

(Supersedes Contract No.071B9000422 )

between

THE STATE OF MICHIGAN

and

|NAME & ADDRESS OF VENDOR |TELEPHONE 517-281-3132 cell |

|AmerisourceBergen Company |800-759-8810 ext 6483 |

|One Industrial Park Dr. |Dale Williams |

|Williamston, MI 48895 |dwilliams@ |

| |VENDOR NUMBER/MAIL CODE |

| | |

| |BUYER/CA (517) 373-4245 |

| |Darleen Burnham-Heim, CPPB |

|Contract Compliance Inspector: Darleen Burnham-Heim |

|Prime Vendor Wholesaler for Pharmaceutical Distribution (includes cost of pharmaceuticals) - Statewide |

|CONTRACT PERIOD: |From: May 1, 2004 |To: April 30, 2006 |

|TERMS |SHIPMENT |

| Net 7; 15; 30 days | Next Business Day ARO |

|F.O.B. |SHIPPED FROM |

| Destination | Williamston, MI |

|MINIMUM DELIVERY REQUIREMENTS |

|All facilities will receive one (1) free delivery per week. Additional delivery charges and emergency delivery charges (if any) are outlined on the |

|attached pages 14 and 32 of the MMCAP contract #MMS24000. |

THIS CONTRACT IS EXTENDED TO LOCAL UNITS OF GOVERNEMENT.

The terms and conditions of this Contract are those of REQ #071R4001238, the Minnesota Multistate Contracting Alliance for Pharmacy (MMCAP) Contract #MMS24000 which includes Amendment 1, and vendor's agreement signed December 15, 2003. In the event of any conflicts between the specifications, terms and conditions indicated by MMCAP and those indicated by the vendor, those of MMCAP take precedence.

Please note the attached “Fee for Service and Incentives” Cost Structure Chart for Michigan. The cost to the State for Pharmaceuticals is dependent on payment turnaround. Most State of Michigan locations are on the “15 day” plan. The “7 day” plan offers the maximum cost savings. The State is advising facilities to utilize EFT (Electronic Funds Transfer) payment to accomplish this.

Estimated Contract Value: $138,045,532.00

Contact information for AmerisourceBergen:

Account Manager for Michigan: Dale Williams

Cell #517-281-3132 fax#614-253-3951 ph#800-759-8810 ext.6483 dwilliams@

Operations Manager @ Williamston Warehouse : Dave Ormsby

517-655-5433 ext.4202 fax#517-655-1138 ph#800-552-0261

Director North Central Region: Ceci Zeigler

614-253-2721 voice mail 426 phone fax#614-253-3951

czeigler@

Vice President National Accounts: Larry Stepp

4141. fax 804-553-1040

lstepp@

Revised 2/20/03

STATE OF MICHIGAN

PHARMACEUTICAL CONTRACT

MEMBER LIST

DEPARTMENT OF CORRECTIONS

|Chippewa Regional Correctional Facility - 2326 |Huron Valley Men's Prison - 2307 |

|Chippewa Clinical Complex |3201 Bemis Rd. |

|West Tone Road |Ypsilanti, Michigan 48197 |

|Kincheloe Air Force Base |Phone: (734) 572-9520 |

|Kincheloe, Michigan 49784 |Fax: (734) 572-1286 |

|Phone: (906) 495-1005 |Contact: Marty Ewald, Pharmacist Tech. |

|Fax: (906) 495-1084 |Robert Sitz, Pharmacist |

|Contact: Terry Malloy, Pharmacist |DEA #AH 133-2600 |

|DEA #AK 174-1114 (MMCAP= BT2410570) |ID #5301003688 |

|ID #5301003743 |EwaldMK@ |

|MalloyT@ |SitzRP@ |

| | |

|Ionia Maximum Correctional Facility - 2304 |Jackson Regional Pharmacy - 2364 |

|Ionia Clinical Complex |(MMCAP = G Robert Cotton Facility – 2364) |

|1576 W. Bluewater Hwy. |Department of Corrections |

|Ionia, MI 48846 |1780 Parnall Street (MMCAP = 3500 N Elm Street) |

|Phone: (616) 527-4040 |Jackson, MI 49201 |

|Fax: (616) 527-9574 |Phone: (517) 780-6358 |

|Contact: Gary Truelove, Pharmacist |Fax: (517) 780-6357 |

|DEA #AM 226-8894 |Contact: Larry Gardon, Pharmacist |

|ID #5301002118 |Vicki Williams, Pharmacist Assistant |

|TrueloGA@ |DEA # B53865435 (MMCAP = BS3865435) |

| |ID #5601005896 |

| |WilliaV6@ GardonL@ |

| | |

|Marquette Branch Prison - 2305 |Duane L. Waters Hospital - 2306 |

|190 US 41 Hwy. South |3857 Cooper St. |

|(MMCAP = 1960 US 41 Hwy. South) |Jackson, MI 49201 |

|Marquette, Michigan 49855 |Phone: (517) 780-5946 |

|Phone: (906) 226-6531, ext. 350 |Fax: (517) 780-5677 |

|Fax: (906) 226-6557 |Contact: Dave L. Kaiser, Pharmacist |

|Contact: Christine Rice, Pharmacist |DEA #AS 553-1341 |

|DEA #AS 781-2109 |ID #5301000735 |

|ID #5301003317 |KaiserDL@ |

|RiceC@ | |

| | |

|Newberry Correctional Facility - 2391 |Ojibway Correctional Facility - 2390 |

|3001 Newberry Avenue |N5705 Ojibway Road |

|Newberry, MI 49868 |Marenisco, MI 49947 |

|Phone (906) 293-6200 Ext. 6392 |Phone: (906) 787-2217 Ext. 191 |

|Fax: (906) 293-6302 |Fax: (906) 787-2582 |

|Contact: Peggy A. Green, RN Supervisor |Contact: Janet Wilbanks-Wing |

|DEA # AW 3006562 |DEA # |

|GreenPA@ |WilbanJK@ |

| | |

| | |

Pharmaceutical Contract

Member List

Page 2

DEPARTMENT OF MILITARY AFFAIRS

|D. J. Jacobetti Home for Veterans - 2318 |Grand Rapids Home for Veterans - 2319 |

|425 Fisher St. |3000 Monroe Ave. |

|Marquette, Michigan 49855 |Grand Rapids, Michigan 49505 |

|Phone: (906) 226-3576, ext. 355 |Phone: (616) 364-5350 |

|Fax: (906) 226-9533 |Fax: (616) 364-5286 |

|Contact: Robert Flatt, Pharmacist |Contact: George Chalmers, Pharmacist |

|DEA #BD 275-0734 |DEA #AM 911-2690 |

|ID #5301005604 |ID #5301000666 |

|FlattR@ |ChalmersG@ |

DEPARTMENT OF COMMUNITY HEALTH

|Caro Center - 2310 |Center for Forensic Psychiatry - 2314 |

|2000 Chambers Road |3501 Willis Rd. Mail to: PO Box 2060 |

|Caro, Michigan 48723 |Building C-6 Ann Arbor, MI 48106 |

|Phone: (989) 673-3191, ext. 412 |Milan, Michigan 48160 |

|Fax: (989) 673-0064 |Phone: (734) 429-2531, ext. 517 |

|Contact: Tom Halanski, Pharmacist |Fax: (734) 429-8261 |

|DEA #AD 311-9357 |Contact: William Plath, Pharmacist |

|ID #530100559 |DEA #AC 707-9040 |

|HalanskiT@ |ID #5301005874 |

| |PlathW@ |

| | |

|Hawthorn Center Hospital - 2315 |Huron Valley Center - 2359 |

|18471 Haggerty Rd. |3511 Bemis Rd. |

|Northville, Michigan 48167 |Ypsilanti, MI 48197 |

|Phone: (248) 735-5994 |Phone: (734) 434-3873 |

|Fax: (248) 349-6893 |Fax: (734) 434-2881 |

|Contact: David Thompson, Pharmacist |Contact: Cathy Neuman, Pharmacist |

|DEA #AH 453-9980 |Edith Stewart, Pharmacist Tech. |

|ID #5301000760 |DEA #BH 411-0449 |

|ThompsonDav@ |ID #5301006114 |

| |Stewart@ |

| | |

|Kalamazoo Regional Hospital - 2312 |Mt. Pleasant Center - 2316 |

|(MMCAP = Kalamazoo Psychiatric Hospital – 2312) |1400 W. Pickard |

|P.O. Box A |Mt. Pleasant, Michigan 48858 |

|(MMCAP = 1312 Oakland Dr. Box A) |Phone: (989) 773-7921, ext. 2126 |

|Oakland Dr. |Fax: (989) 772-5093 |

|Kalamazoo, Michigan 49008 |Contact: Pam Stinson, Pharmacist |

|Phone: (616) 337-3106 |DEA #AM 446-9474 |

|Fax: (616) 337-3007 |ID #5301001112 |

|Contact: Anita Stolle, Pharmacist |StinsonPam@ |

|DEA #AS 226-8870 | |

|ID #530100622 | |

|StolleA@ | |

| | |

| | |

Pharmaceutical Contract

Member List

Page 3

DEPARTMENT OF COMMUNITY HEALTH (Continued)

|Department of Community Heath - 2320 |Walter P. Reuther Psychiatric Hospital - 2317 |

|General Services Purchasing |30901 Palmer Rd. |

|3500 N. Logan St. |Westland, Michigan 48185 |

|Lansing, Michigan 48906 |Phone: (734) 367-8576 |

|Phone: (517) 241-2305 |Fax: (734) 722-6891 |

|Fax: (517) 335-8121 |Contact: Carey Abbott, Pharmacist |

|Contact: Shirley Martin |DEA #AW 916-1085 |

|DEA #AH 953-8022 |ID #5301001649 |

|ID #690100319 |AbbottC@ |

|MartinS@ | |

| | |

|Michigan Career and Technical Institute - 2396 |W.J. Maxey Boy’s Training School - 2378 |

|11611 West Pin Lake Road |9036 East M-36 |

|Plainwell, MI 49080 |Whitmore Lake, MI 48189 |

|Phone: (616) 664-4461 |Phone: (313) 449-4422 |

|Fax: (616) 664-5850 |Fax: (313) 449-5861 |

|Contact: Elizabeth Carrington |Contract: Kathy Alstott |

|DEA #BKO482276 (MMCAP = BK0482276) |DEA #BN141-4642 |

|CarringtonE@ |AlstottK@ |

| | |

Pharmaceutical Contract

Member List

Page 4

LOCAL UNITS OF GOVERNMENT

|Dearborn Health Department - 2365 |Hiawatha Behavioral Health - 2388 |

|16301 Michigan Avenue |125 N. Lake St. |

|Dearborn, MI 48126 |Manistique, MI 49854 |

|Phone: (313) 943-2375 |Phone: (906) 341-2144 |

|Fax: (313) 943-2420 |Fax: (906) 341-5793 |

|Contact: Rebecca Sweet |Contact: Joanne Pratt, Contract/Procurement |

|DEA #BT 3895399 |DEA #AW 3049827 |

|e-mail: rsweet@ci.dearborn.mi.us |e-mail: jkpratt@ |

| | |

|Huron County Health Department - 2336 |Ingham County Health Department - 2337 |

|1142 South Van Dyke |5303 S. Cedar Street |

|Bad Axe, MI 48413 |Lansing, MI 489909-7661 |

|Phone: (989) 269-9721 |Phone: (517) 887-4323 |

|Fax: (989) 269-4181 |Fax: (517) 887-4310 |

|Contact Cindy Gentner, R.N. |Contact: Jackie Baumchen |

|DEA #BS1957476 |DEA #BS174-0465 |

|ID # |e-mail: hfbaumchen@ |

|e-mail: | |

| | |

|Jackson County Health Department - 2366 |Marquette County Health Department - 2375 |

|1697 Lansing Avenue |184 U.S. 41 Highway |

|Jackson, MI 49202 |Negaunee, MI 49866 |

|Phone: (517) 788-4420 X 156 |Phone: (906) 475-9977 |

|Fax: (517) 788-4373 |Fax: (906) 475-9312 |

|Contact: Mary Ricciardello |Contact: Randall Johnson, M.D., Medical Director |

|DEA #BG 4006563 |DEA # |

|ID # |ID # |

|Mricciar@co.jackson.mi.us |e-mail: rjohnson@hline. |

| | |

|Martha T. Berry Medical Care Facility - 2387 |Oakland County Medical Care Facility - 2321 |

|43533 Elizabeth Road |1200 North Telegraph Rd. |

|Mt. Clemens, MI 48043 |Pontiac, Michigan 48341 |

|Phone: (586) 469-5603 |Phone: (248) 858-7678 |

|Fax: (586) 469-6352 |Fax: (248) 858-1677 |

|Contact: Harry Lebovic, Director of Pharmacy |Contact: Bob Rhein |

|DEA #AM 5040251 |DEA #A0 534-7314 |

|ID: |ID #5301000842 |

|e-mail: harry.lebovic@co.macomb.mi.us |e-mail: rheinr@co.oakland.mi.us |

| | |

|Shiawassee County Health Department - 2349 |Sterling Heights Fire Department - 2385 |

|110 East Mack St. |41625 Ruan Road |

|Corunna, MI 48817 |Sterling Heights, MI 48314 |

|Phone: (989) 743-2355 |Phone: (586) 446-2953 |

|Fax: (989) 743-2362 |Fax: (586) 726-7007 |

|Contact: Rose Mary Asman, Director of Personal Hlth |Contact: Dominic Calderone, EMS Coordinator |

|DEA #AC1546817 |DEA #AA 9521685 |

|ID # |e-mail: dcalderone@sterling- |

|Rasman@ | |

| | |

|Wayne County Jail Pharmacy - 2360 |Calhoun County Health Department - 2386 |

|3501 Hamtramck Dr. (MMCAP = 570 Clinton St.) |190 E. Michigan Ave. |

|Hamtramck, Michigan 48211 |Battle Creek, MI 49017 |

|(MMCAP = Detroit, MI 48226) |Phone: (616) 781-0815 |

|Phone: (313) 875-4423* |Fax: (616) 781-0140 |

|Fax: (313) 224-2368 |Contact: Bradley J. Wilcox, CPPB |

|Contact: Greg Dworzanin, Pharmacist |DEA #B133-72339 |

|(313) 875-8485 |ID #386004358 |

|DEA #AW 868-0185 |e-mail: bwilcox@calhoun- |

|ID #5301003163 | |

|e-mail: Gdworzam@co.wayne.mi.us | |

Pharmaceutical Contract

Member List

Page 5

COLLEGES, UNIVERSITIES, HEALTH DEPARTMENTS

|Eastern Michigan University Pharmacy - 2301 |Northern Michigan University - 2302 |

|Snow Health Services, Room 220 |Health Center (MMCAP = 1401 Presque Isle Ave.) |

|Ypsilanti, Michigan 48197 |Marquette, Michigan 49855 |

|Phone: (734) 487-1003 |Phone: (906) 227-1165 |

|Fax: (734) 487-0050 |Fax: (906) 227-2332 |

|Contact: Jerry Vidis, Pharmacist |Contact: Jan Nolan, Pharmacist |

|DEA #AW 226-8882 |DEA #AU 471-9843 |

|jerry.vidis.@emich.edu |ID #5301002840 |

| |jnolan@nmu.edu |

| | |

|Western Michigan University - 2357 |Northwestern Michigan College - 2398 |

|Sindecuse Health Center |Student Health Service |

|Gilkison Drive |1701 E. Front Street |

|Kalamazoo, MI 49008 |Traverse City, MI 49686 |

|Phone: (616) 387-3301 |Phone: (231) 995-1130 |

|Fax: (616) 387-2205 |Fax: (231) 995-1129 |

|Contact: Bill Green |Contact: Steve Westphal |

|DEA # AD 2268399 |DEA # AD 1880752 |

| |swestphal@nmc.edu |

|Herman Kiefer Health Complex - 2399 |Genesee County Health Dept. - 2368 |

|City of Detroit |630 S. Saginaw Street |

|1151 Taylor Ave. |Flint, MI 48502-1540 |

|Detroit, MI 48202 |Phone: (810) 257-3156 |

|Phone: (313) 876-4010 |Fax: (810) 257-3147 |

|Fax: (313) 876-0512 |Contact: Caroline Ratza |

|Contact: Tara Jenkins |DEA #AJ 105-7581 |

|DEA # AH 5220900 |CRatza@co.genesee.mi.us |

|jenkinst@health.ci.detroit.mi.us | |

Revised 01/03/03

STATE OF MICHIGAN

PHARMACEUTICAL CONTRACT

VACCINE ONLY

(Local Units of Government - Direct Orders)

MEMBER LIST

|Barry Eaton District Health Department - 2377 |Dearborn Health Department - 2365 |

|528 Beech Street |16301 Michigan Ave. |

|Charlotte, MI 48813 |Dearborn, MI 48126 |

|Phone: 517/543-2430 x 674 |Phone: (313) 943-3082 |

|Fax: 517/543-7737 |Fax: (313) 943-2312 |

|Contact: Wendy Jorgensen |Contact: Joan Gumkowski, Health Director |

|DEA #BS 174-0465 |DEA #BT 389-5399 |

|jorgensenwendy@ |e-mail: Jgumkows@ci.dearborn.mi.us |

| | |

|Public Health - Delta and Menominee Counties - 2327 |Dickinson-Iron District Health Dept. - 2382 |

|2920 College Ave. |818 Pyle Drive |

|Escanaba, MI 49829 |Kingsford, Mi 49802 |

|Phone: (906) 786-4111 Ext.121 |Phone: (906) 779-7210 |

|Fax: (906) 786-1962 |Fax: (906) 774-9910 |

|Contact: Kathy Cole |Contact: Denise Berland, Office Coordinator |

|DEA #BP 190-5186 |DEA #4301040842 (MMCAP = No DEA#) |

|kcole@phdm. |e-mail: Dberland@ |

| | |

|District Health Department #3 – Not on MMCAP |Ferris State University - 2332 |

|220 W. Garfield Street |Birkam Health Center |

|Charlevoix, MI 49720 |1019 Campus Dr. |

|Phone: (231) 547-6523 |Big Rapids, MI 49307-2280 |

|Fax: (231) 547-6238 |Phone: (231) 591-2614 |

|Contact: Dawn Fletcher |Contact: Joe Ward |

|DEA #AY 955-1006 |DEA #AF 415-9403 |

|D.Fletcher@ |e-mail: wardj@ferris.edu |

| | |

|Friendship Centers of Emmett County - 2363 | |

|1322 Anderson Road | |

|Petosky, MI 49770 | |

|Phone: (231) 347-3211 | |

|Fax: (231) 347-3795 | |

|Contact: Susan Berkau | |

|DEA #AW 525-0472 | |

|Sberkau@ | |

| | |

|Grand Traverse County Health Dept. - 2362 |Grand Valley State University - 2335 |

|2325 Garfield Road, North |Butterworth Health Corp. |

|Traverse City, MI 49686 |Central Receiving, 163 Fieldhouse |

|Phone: (231) 922-2743 |Allendale, MI 49401 |

|Fax: (231) 922-2719 |Phone: (616) 988-8774 |

|Contact: Kit Mikovitz |Fax: (616) 894-2440 |

|DEA #AC 652-8701 |Contact: Mary Jo Miedema |

|Kmikovit@co.grand-traverse.mi.us |DEA #AP7751775 |

| |Miedemam@gvsu.edu |

| | |

|Huron County Health Department - 2336 |Ionia County Health Dept. - 2339 |

|1142 South Van Dyke |175 E. Adams |

|Bad Axe, MI 48413 |Ionia, MI 48846 |

|Phone: (989) 269-9721 |Phone: (616) 527-5341 |

|Fax: (989) 269-4181 |Fax: (616) 527-5361 |

|Contact: Cindy Gentner, R.N., Public Hlth Dir. |Contact: Lori Clover |

|DEA #BS 1957476 |DEA #BS 174-0465 |

|e-mail: Cgentner@ |Lclover@ |

Pharmaceutical Contract

Vaccine Only

Member List

Page 2

| | |

|Jackson County Health Dept. - 2366 |Kalamazoo County Human Services - 2369 |

|1697 Lansing Avenue |Nazareth Complex |

|Jackson, MI 49202 |3299 Gull Rd. |

|Phone: (517) 788-4420 |Kalamazoo, MI 49001-1295 |

|Fax: (517) 788-4373 |Phone: (616) 373-5237 |

|Contact: Mary Ricciardello |Fax: (616) 373-5362 |

|DEA #BG 4006563 |Contact: Michelle Thor |

|e-mail: MRICCIAR@CO.JACKSON.MI.US |DEA #AT 320-7811 |

| |MRThor@ |

| | |

|Kent County Health Dept. - 2367 |Lenawee County Health Department - 2340 |

|700 Fuller Ave. NE |1040 S. Winter St., Suite 2328 |

|Grand Rapids, MI 49503 |Adrian, MI 49221-3871 |

|Phone: (616) 336-3502 |Phone: (517) 264-5206 |

|Fax: (616) 336-2440 |Fax: (517) 264-5212 |

|Contact: Jon Denhof |Contact: Mike Ernst |

|DEA #AM 233-4857 |DEA #AC 154-6817 |

|Jon.denhof@ |MikeE@ |

| | |

|Livingston County Health Department - 2341 |Macomb County Health Department - 2361 |

|2300 E. Grand River |43525 Elizabeth Rd. |

|Howell, MI 48843-7578 |Mt. Clemens, MI 48043 |

|Phone: (517) 546-9850 |Phone: (810) 469-5512 |

|Fax: (517) 546-6995 |Fax: (810) 469-5885 |

|Contact: Lillian Van Houten |Contact: Thomas Kalkofen |

|DEA #BB 445-1681 (MMCAP = AE3089516) |DEA #BL 203-2732 |

|LVANHOUTEN@CO.LIVINGSTON.MI.US |Tom.kalkofen@co.macomb.mi.us |

| | |

|Mecosta County Health Dept. - 2370 |Monroe County Health Dept. - 2346 |

|400 Elm St. |2353 South Custer Rd. |

|Big Rapids, MI 49307 |Monroe, MI 48161 |

|Phone: (231) 876-3835 |Phone: (734) 240-7831 |

|Fax: (231) 796-7864 |Fax: (734) 240-7906 |

|Contact: Marilyn Pratt |Contact: Patsy Bourgeois |

|DEA #AN 310-9964 |DEA #AL 672-3034 |

|e-mail: marilynpratt@ |e-mail: Patsy_Bourgeois@ |

| | |

|Oakland County Health Division - 2372 |Richmond Lenox EMS - 2384 |

|27725 Greenfield Road |34505 32 Mile Road |

|Southfield, MI 48076 |Richmond, MI 48062 |

|Phone: (248) 424-7000 |Phone: (586) 727-2184 |

|Fax: (810) 858-5639 |Contact: Jeff White, Director |

|Contact: Carolyn Bird |DEA #AA 952-1685 |

|DEA #BB 250-0216 |Rlemscl@ |

|e-mail: whitep@co.oakland.mi.us | |

| | |

|City of Saginaw - 2352 |Sanilac County Health Dept. - 2371 |

|1315 S. Washington |171 Dawson |

|Saginaw, MI 48601 |Sandusky, MI 48471 |

|Phone: (989) 759-1443 |Phone: (810) 648-4098 |

|Fax: (989) 759-1498 |Fax: (810) 648-2646 |

|Contact: Tanya Simon |Contact: Jane Dumaw |

|DEA #AOW 484-7779 (MMCAP = AW4847779) |DEA #AS 311-7290 |

|tsimon@ |e-mail: jdumaw@ |

Pharmaceutical Contract

Vaccine Only

Member List

Page 3

| | |

|Shiawassee County Health Department - 2349 |St.Clair County Health Department - 2380 |

|110 East Mack St. |3415 28th St. |

|Corunna, MI 48817 |Port Huron, MI 48060 |

|Phone: (517) 743-2355 |Phone: (810) 987-5300 |

|Fax: (517) 743-2362 |Fax: (810) 985-4487 |

|Contact: Rose Mary Asman |Contact: Cheryl Smith, RN, Nursing Supervisor |

|DEA# AC154-6817 |DEA# AH 770-3689 |

|e-mail: Rasman@ |e-mail: CLSmith@hd. |

| | |

|City of Troy - 2373 |Tuscola County Health Department - 2379 |

|Troy Medical Center Management Co. |1309 Cleaver Road |

|1663 Stephenson Hwy. |Caro, MI 48723 |

|Troy, MI 48083 |Phone: (673-8114 ext. 143 |

|Phone: (248) 619-7267 |Fax: 517/673-7490 |

|Contact: Linda Bockstaz |Contact: Bonnie Sammons, Fiscal Manager |

|DEA #AG 310-1160 |DEA #BS195-7476 |

|e-mail: BockstLn@ci..troy.mi.us |Bonnie.Sammons@Hline. |

| | |

|Washtenaw County Health Department - 2376 |Western UP District Health - 2358 |

|555 Towner, HSB1/121 |540 Depot St. |

|Ypsilanti, MI 48198 |Hancock, MI 49930 |

|Phone: (313) 994-2388 |Phone: (906) 482-7382 |

|Fax: 313/484-7202 |Fax: (906) 482-9410 |

|Contact: Linda Lantry |Contact: Barbara Auten |

|DEA #BB 445-1681 |DEA #AS 823-9546 |

|e-mail: |e-mail: Bauten@ |

| | |

|District Health Department #10 - 2389 |LMAS District Health Department - 2392 |

|521 Cobbs St. (MMCAP = 401 Lake Street) |14150 Hamilton Lake Rd. |

|Cadillac, MI 49601 |Newberry, MI 49868 |

|Phone: (231) 876-3835 |Phone: (906) 293-1332 |

|Fax: (231) 775-5372 |Contact: Paula Charbonneau |

|Contact: Marilyn Pratt, RN |DEA #BT2410570 |

|DEA #448-1957 (MMCAP = No DEA) |Pcharbon@ |

|e-mail: marilynpratt@ | |

|Allegan County Health Department - 2394 |Chippewa County Health Department - 2326 |

|2233 33rd Street |508 Ashmun St., Suite 120 |

|Allegan, MI 49010 |Sault Ste. Marie, Mi 49783 |

|Phone: (616) 673-5411 |Phone: (906) 635-3579 |

|Fax: (616) 673-4172 |Fax: (906) 635-1701 |

|Contact: Roberta Reyes, Health Secretary |Contact: Jams Terrian, MD, Health Officer |

|DEA # BT5781629 |DEA #BT2410570 |

|rreyes@ |jterrian@ |

| | |

Pharmaceutical Contract

Vaccine Only

Member List

Page 4

|Lapeer County Health Department - 2397 |Berrien County Health Department - 2395 |

|1800 Inley City Road |769 Pipestone (P.O. Box 706) |

|(MMCAP = 1575 Suncrest Dr.) |Benton Harbor, MI 49023 |

|Lapeer, MI 48446 |Phone: (616) 927-5610 |

|Phone: (810) 667-0391 |Fax: (616) 926-8129 |

|Fax: (810) 667-0232 |Contact: Mara Boetlcher, Finance Director |

|Contact: Barb Harmon, Pub. Health Secretary |DEA: #AJ 7593420 |

|DEA #BL2146430 |Email: Mboettcher@ |

|sdmercer@ | |

| | |

|District Health Department #4 - 2330 | |

|100 Woods Circle, Suite 200 | |

|Alpena, MI 49707 | |

|Phone: (800) 221-0294 | |

|Phone: (989) 356-4507 | |

|Fax: (989) 356-3529 | |

|Contact: Amy Fournier | |

|DEA #BM4125894 (MMCAP = AY9551006) | |

|ID #383145897 | |

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download