23D2184101 CLIA NUMBER - PCA CORRECTIONS, LLC DBA SYNCHRONY GRAND RAPIDS PHARMACY

Laboratory Demographics

CLIA Number: 23D2184101

Facility Name: PCA CORRECTIONS, LLC DBA SYNCHRONY GRAND RAPIDS PHARMACY

Facility Address:
4665 44TH STREET SE SUITE A 1106
GRAND RAPIDS, MI
ZIP 49512
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Facility Phone Number: 616 977-9700

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1083849640

Taxonomy: 3336L0003X - Pharmacy
A pharmacy that dispenses medicinal preparations delivered to patients residing within an intermediate or skilled nursing facility, including intermediate care facilities, hospice, assisted living facilities, group homes, and other forms of congregate living arrangements.

CLIA Record

Field Name	Field Value
CLIA Number	23D2184101
LAB Type	Pharmacy
Facility Name	PCA CORRECTIONS, LLC DBA SYNCHRONY GRAND RAPIDS PHARMACY
Street	4665 44TH STREET SE SUITE A 1106
City	GRAND RAPIDS
State	MI
ZIP	49512
Phone	616 977-9700
CertificateType	4
CertificateEffectiveDate	5/14/2024
CertificateExpirationDate	5/13/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024