Covered Entity Details

DSH230020 Oakwood Healthcare, Inc. d/b/a Corewell Health Dearborn Hospital (Active) - information as of 5/13/2025 10:52:57 PM

Main Details

Name

Oakwood Healthcare, Inc. d/b/a Corewell Health Dearborn Hospital

Subdivision Name

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH230020

Medicare Provider Number

230020

Additional Details

Current Program Status

Active

Registration Date

6/1/2006

Participating Start Date

7/1/2006

Participating Approval Date

6/5/2006

Last Recertification Date

9/6/2024

Contacts

Authorizing Official

Corewell Health
Hardik Dalal, SVP, Finance & System-wide Pharmacy Finance
(312) 771-0810

Primary Contact

Corewell Health
Thomas Schaible, Mgr, Pharmacy CHE
(947) 522-1169

Addresses

Street Address

18101 OAKWOOD BOULEVARD
DEARBORN, MI 48124

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
6/27/2011 - DOC. RECD. TO CONFIRM NON-PROFIT STATUS 3/24/2010- DOC. RECD. TO CONFIRM ELIG. OWNERSHIP TYPE	07/06/2011
6/27/2011 - DOC. RECD. TO CONFIRM NON-PROFIT STATUS 3/24/2010- DOC. RECD. TO CONFIRM ELIG. OWNERSHIP TYPE	07/06/2011

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
MI		1740230119

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	07/13/2019	10/01/2019		10/01/2019
Contract Detail	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	07/13/2019	10/01/2019		10/01/2019
Contract Detail	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	07/13/2019	10/01/2019		10/01/2019
Contract Detail	ACCREDO HEALTH GROUP INC	39625 LEWIS DR	STE 800	NOVI	MI	48377-2962	10/16/2023	01/01/2024		01/01/2024
Contract Detail	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	07/13/2019	10/01/2019		10/01/2019
Contract Detail	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	07/13/2019	10/01/2019	10/13/2023	01/11/2024
Contract Detail	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	07/13/2019	10/01/2019		10/01/2019
Contract Detail	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	04/07/2023	07/01/2023		07/01/2023
Contract Detail	AVELLA OF ST LOUIS	450 N NEW BALLAS RD STE 256		SAINT LOUIS	MO	63141-6836	04/15/2019	07/01/2019	07/01/2021	07/13/2021
Contract Detail	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	376 NORTHLAKE BLVD		ALTAMONTE SPRINGS	FL	32701-5261	10/16/2023	01/01/2024		01/01/2024
Contract Detail	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4900 PROSPECTUS DR STE 300		DURHAM	NC	27713	07/11/2024	10/01/2024		10/01/2024
Contract Detail	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4740 VICTORY LN STE C	INDIANAPOLIS	IN	46203	07/11/2024	10/01/2024		10/01/2024
Contract Detail	BRIOVARX OF MAINE INC	DBA BRIOVARX	53 DARLING AVE	SOUTH PORTLAND	ME	04106	04/15/2019	07/01/2019	10/01/2019	11/20/2019
Contract Detail	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	10/15/2018	01/01/2019		01/01/2019
Contract Detail	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	10/15/2018	01/01/2019		01/01/2019
Contract Detail	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	10/15/2018	01/01/2019		01/01/2019
Contract Detail	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	07/14/2021	10/01/2021		10/01/2021
Contract Detail	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	10/15/2018	01/01/2019		01/01/2019
Contract Detail	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	10/15/2018	01/01/2019		01/01/2019
Contract Detail	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	07/14/2021	10/01/2021		10/01/2021
Contract Detail	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	07/14/2021	10/01/2021		10/01/2021
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	10/15/2018	01/01/2019		01/01/2019
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	07/14/2021	10/01/2021		10/01/2021
Contract Detail	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	11/08/2021	11/08/2021		11/08/2021
Contract Detail	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	11/08/2021	11/08/2021		11/08/2021
Contract Detail	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	07/14/2021	10/01/2021		10/01/2021
Contract Detail	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	07/17/2018	10/01/2018		10/01/2018
Contract Detail	DIPLOMAT SPECIALTY PHARMACY	4100 S SAGINAW ST	STE D	FLINT	MI	48507-2683	07/13/2021	10/01/2021	03/31/2022	01/11/2024
Contract Detail	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	07/15/2022	10/01/2022		10/01/2022
Contract Detail	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	07/15/2022	10/01/2022		10/01/2022
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	07/15/2022	10/01/2022		10/01/2022
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	07/15/2022	10/01/2022		10/01/2022
Contract Detail	GOOD NEIGHBOR'S FAMILY PHARMACY	GOOD NEIGHBOR'S FAMILY PHARMACY	1956 S VENOY RD	WESTLAND	MI	48186	07/13/2021	10/01/2021	10/07/2023	10/16/2023
Contract Detail	HENRY FORD PHARMACY ADVANTAGE SOUTHFIELD	1191 SOUTH BLVD. E.		ROCHESTER HILLS	MI	48307	04/15/2015	07/01/2015	09/29/2017	10/23/2017
Contract Detail	KROGER CO OF MICHIGAN #579	3833 NORTH DIXIE HIGHWAY		MONROE	MI	48162	04/15/2019	07/01/2019	10/15/2019	11/20/2019
Contract Detail	KROGER PHARMACY	16705 FORT ST.		SOUTHGATE	MI	48195	04/15/2019	07/01/2019	10/15/2019	11/20/2019
Contract Detail	MEDCART SPECIALTY PHARMACY	32131 INDUSTRIAL RD.		LIVONIA	MI	48150	07/13/2021	10/01/2021		10/01/2021
Contract Detail	MEIJER DISTRIBUTION INC #90	2721 WALKER AVE NW		GRAND RAPIDS	MI	49544	01/14/2019	04/01/2019		04/01/2019
Contract Detail	MEIJER INC #208	3710 DIX HIGHWAY		LINCOLN PARK	MI	48146	01/14/2019	04/01/2019		04/01/2019
Contract Detail	MEIJER INC #233	3565 FAIRLANE BLVD		ALLEN PARK	MI	48101	01/14/2019	04/01/2019		04/01/2019
Contract Detail	MEIJER PHARMACY #464	41255 COCA COLA DR.		BELLEVILLE	MI	48111-1827	01/14/2019	04/01/2019		04/01/2019
Contract Detail	MEIJER STORES LIMITED PARTNERSHIP	D/B/A MEIJER PHARMACY #463	1515 PROFIT DR.	FORT WAYNE	IN	46808	01/14/2019	04/01/2019		04/01/2019
Contract Detail	OAKWOOD HEALTHCARE INC	DBA - COREWELL HEALTH TAYLOR HOSPITAL	10000 TELEGRAPH RD	TAYLOR	MI	48180	10/15/2019	01/01/2020	03/31/2022	04/08/2022
Contract Detail	OAKWOOD HEALTHCARE, INC.	DBA - BEAUMONT PHARMACY CANTON	7330 CANTON CENTER ROAD SUITE #115	CANTON	MI	48187	01/03/2011	01/03/2011	08/04/2019	10/08/2019
Contract Detail	OAKWOOD HEALTHCARE, INC.	DBA - COREWELL HEALTH RETAIL PHARMACY WE	2001 S MERRIMAN RD STE 200	WESTLAND	MI	48186	01/03/2011	01/03/2011	08/04/2019	10/08/2019
Contract Detail	OAKWOOD HEALTHCARE, INC.	DBA - COREWELL HEALTH RETAIL PHARMACY -	18181 OAKWOOD BLVD STE 108	DEARBORN	MI	48124	06/01/2008	06/01/2008		01/24/2019
Contract Detail	OAKWOOD HEALTHCARE, INC.	DBA - COREWELL HEALTH RETAIL PHARMACY -	5450 FORT ST	TRENTON	MI	48183	01/03/2011	01/03/2011	08/04/2019	10/08/2019
Contract Detail	OAKWOOD HEALTHCARE, INC.	DBA - BEAUMONT PHARMACY SOUTHGATE	15777 NORTHLINE RD STE 100A	SOUTHGATE	MI	48195-2300	01/03/2011	01/03/2011	08/04/2019	10/08/2019
Contract Detail	OAKWOOD HEALTHCARE, INC.	DBA - COREWELL HEALTH RETAIL PHARMACY -	33155 ANNAPOLIS ST	WAYNE	MI	48184	01/03/2011	01/03/2011	08/04/2019	10/08/2019
Contract Detail	OAKWOOD INFUSION SERVICES, LLC		1633 FAIRLANE CIRCLE SUITE #165	ALLEN PARK	MI	48101	02/24/2011	03/10/2011	05/23/2016	11/01/2016
Contract Detail	ONCOMED THE ONCOLOGY PHARMACY OF BUFFALO	D/B/A ONCO360	140 JOHN JAMES AUDUBON PKWY STE 101	AMHERST	NY	14228	07/14/2023	10/01/2023		10/01/2023
Contract Detail	OPTION CARE ENTERPRISES, INC.	D/B/A OPTION CARE	11403 BLUEGRASS PARKWAY SUITE 400	LOUISVILLE	KY	40299-2398	04/14/2020	07/01/2020		07/01/2020
Contract Detail	OPTION CARE ENTERPRISES, INC.	DBA OPTION CARE	27005 HILLS TECH COURT	FARMINGTON HILLS	MI	48331-5723	04/14/2020	07/01/2020		07/01/2020
Contract Detail	OPTUM PHARMACY 701, LLC	4100 S SAGINAW ST STE D		FLINT	MI	48507	04/08/2022	04/13/2022		04/19/2022
Contract Detail	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	04/15/2019	07/01/2019		07/01/2019
Contract Detail	OPTUM PHARMACY 705, LLC	3539 BLUECUTT RD		COLUMBUS	MS	39705	07/13/2021	10/01/2021		10/01/2021
Contract Detail	OPTUM PHARMACY 705, LLC	1100 LEE BRANCH LN		BIRMINGHAM	AL	35242-7298	04/07/2023	07/01/2023		07/01/2023
Contract Detail	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	04/15/2019	07/01/2019		07/01/2019
Contract Detail	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	07/17/2018	10/01/2018	10/01/2022	11/29/2022
Contract Detail	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	10/15/2018	01/01/2019		01/01/2019
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	07/14/2021	10/01/2021		10/01/2021
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	07/14/2021	10/01/2021		10/01/2021
Contract Detail	RAINA RX LLC	DBA ROUTE 300 PHARMACY	1208 ROUTE 300 SUITE 103	NEWBURGH	NY	12550	10/16/2023	01/01/2024		01/01/2024
Contract Detail	RIVER MEDICAL PHARMACY LLC	4752 RESEARCH DR		SAN ANTONIO	TX	78240-5002	10/16/2023	01/01/2024		01/01/2024
Contract Detail	SINA DRUG LLC	DBA ONCO360	1985 MARCUS AVE STE 120	NEW HYDE PARK	NY	11042	07/14/2023	10/01/2023		10/01/2023
Contract Detail	SINA DRUG LLC	D/B/A ONCO 360	13410 EASTPOINT CENTRE DR STE 101	LOUISVILLE	KY	40223	07/14/2023	10/01/2023		10/01/2023
Contract Detail	SORKIN'S RX LTD	D/B/A CAREMED PHARMACEUTICAL SERVICES	1985 MARCUS AVE STE 130	NEW HYDE PARK	NY	11042-2024	07/14/2023	10/01/2023		10/01/2023
Contract Detail	SUPERX DRUG CORPORATION	DBA THE KROGER CO #691	36430 FORD ROAD	WESTLAND	MI	48185	04/15/2019	07/01/2019	10/15/2019	11/20/2019
Contract Detail	THE KROGER CO MICHIGAN 686	7000 MONROE		TAYLOR	MI	48180	04/15/2019	07/01/2019	07/05/2024	07/11/2024
Contract Detail	THE KROGER CO OF MI #693	2060 DIX AVENUE		LINCOLN PARK	MI	48146	04/15/2019	07/01/2019	12/09/2023	01/11/2024
Contract Detail	THE KROGER CO OF MICHIGAN	23303 MICHIGAN AVENUE		DEARBORN	MI	48124	04/15/2019	07/01/2019	07/05/2024	07/11/2024
Contract Detail	THE KROGER CO OF MICHIGAN 441	26400 FORD ROAD		DEARBORN HEIGHTS	MI	48127	04/15/2019	07/01/2019	10/15/2019	11/20/2019
Contract Detail	THE KROGER CO OF MICHIGAN 458	23849 WEST ROAD		BROWNSTOWN TOWNSHIP	MI	48134	04/15/2019	07/01/2019	10/15/2019	11/20/2019
Contract Detail	THE KROGER CO OF MICHIGAN 708	20645 GIBRALTAR RD.		BROWNSTOWN	MI	48183	04/15/2019	07/01/2019	10/15/2019	11/20/2019
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	01/15/2019	04/01/2019	06/15/2024	07/11/2024
Contract Detail	WAL-MART PHARMACY 10-2912	7555 TELEGRAPH ROAD		TAYLOR	MI	48180	01/15/2019	04/01/2019	06/15/2024	07/11/2024
Contract Detail	WAL-MART PHARMACY 10-4383	5851 MERCURY DRIVE		DEARBORN	MI	48126	01/15/2019	04/01/2019	06/15/2024	07/11/2024
Contract Detail	WAL-MART PHARMACY 10-5315	2354 COMMERCE PARK DR.		ORLANDO	FL	32819	01/15/2019	04/01/2019	06/15/2024	07/11/2024
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	01/15/2019	04/01/2019	06/15/2024	07/11/2024
Contract Detail	WALGREEN CO	DBA: WALGREENS #11456	25700 FORD RD	DEARBORN HEIGHTS	MI	48127	07/17/2018	10/01/2018		10/01/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 01265	3221 FORT ST	WYANDOTTE	MI	48192-5312	07/17/2018	10/01/2018		10/01/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 02023	1285 N MONROE ST	MONROE	MI	48162-3115	07/17/2018	10/01/2018		10/01/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04498	20090 GODDARD ROAD	TAYLOR	MI	48180	07/17/2018	10/01/2018		10/01/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04585	17071 FORT STREET	RIVERVIEW	MI	48193	07/17/2018	10/01/2018		10/01/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04749	1765 FORT ST.	LINCOLN PARK	MI	48146	07/17/2018	10/01/2018		10/01/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04992	15450 MICHIGAN AVE.	DEARBORN	MI	48126	07/17/2018	10/01/2018	03/20/2025	03/20/2025
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05032	13601 W. WARREN AVE.	DEARBORN	MI	48126	07/17/2018	10/01/2018		10/01/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05168	23007 TELEGRAPH RD.	BROWNSTOWN	MI	48134	07/17/2018	10/01/2018		10/01/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05169	1700 WEST ROAD	TRENTON	MI	48183	07/17/2018	10/01/2018		10/01/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05596	15009 TELEGRAPH ROAD	TAYLOR	MI	48180	07/17/2018	10/01/2018	03/17/2025	03/17/2025
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06261	20030 ECORSE RD	TAYLOR	MI	48180	07/17/2018	10/01/2018		10/01/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06546	9100 TELEGRAPH RD	TAYLOR	MI	48180	07/17/2018	10/01/2018		10/01/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07206	5709 S TELEGRAPH RD	DEARBORN HEIGHTS	MI	48125-2025	07/17/2018	10/01/2018		10/01/2018
Contract Detail	WALGREEN CO.	DBA WALGREENS #16097	22525 WICK RD.	TAYLOR	MI	48180	07/17/2018	10/01/2018	03/24/2025	03/24/2025
Contract Detail	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #16374	4501 WOODWARD AVE STE 105	DETROIT	MI	48201	10/08/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04430	120 INKSTER RD	INKSTER	MI	48141	07/13/2021	10/01/2021	03/30/2023	04/07/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04631	32732 MICHIGAN AVE	WAYNE	MI	48184	10/12/2021	01/01/2022		01/01/2022
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04297	7210 N MIDDLE BELT ROAD	WESTLAND	MI	48185	10/12/2021	01/01/2022		01/01/2022
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04367	8706 N. TELEGRAPH ROAD	DEARBORN HEIGHTS	MI	48127	10/12/2021	01/01/2022		01/01/2022
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04933	8850 NEWBURGH RD.	LIVONIA	MI	48150	01/11/2022	04/01/2022		04/01/2022
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06550	44300 FORD RD	CANTON	MI	48187-3169	01/11/2022	04/01/2022		04/01/2022
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07854	31415 FORD RD	GARDEN CITY	MI	48135-1821	01/11/2022	04/01/2022		04/01/2022
Contract Detail	Walgreens #21423	Walgreens Central Fill #21423	6275 Winchester Blvd	Canal WInchester	OH	43110-6537	10/16/2023	01/01/2024		01/01/2024
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	ALLIANCERX WALGREENS PRIME #12314	9775 SW GEMINI DR, STE 1	BEAVERTON	OR	97008	07/17/2018	10/01/2018	10/01/2021	10/12/2021
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	07/17/2018	10/01/2018		10/01/2018
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	07/17/2018	10/01/2018		10/01/2018
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	07/17/2018	10/01/2018		10/01/2018
Contract Detail	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	01/12/2023	04/01/2023	06/15/2024	07/11/2024
Contract Detail	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	10/16/2023	01/01/2024	06/15/2024	07/11/2024
Contract Detail	WILLIAM BEAUMONT HOSPITAL	DBA COREWELL HEALTH SPECIALTY PHARMACY	41965 ECORSE RD STE 100	VAN BUREN TWP	MI	48111	01/12/2017	04/01/2017		01/12/2017
Contract Detail	WILLIAM BEAUMONT HOSPITAL	DBA COREWELL HEALTH HOME INFUSION	31157 WOODWARD AVE STE 101	ROYAL OAK	MI	48073	04/14/2019	07/01/2019		07/01/2019
Contract Detail	WOODWARD DETROIT CVS, L.L.C.	DBA: CVS/PHARMACY # 08131	2400 FORT ST.	LINCOLN PARK	MI	48146	07/17/2018	10/01/2018		10/01/2018
Contract Detail	WOODWARD DETROIT CVS, L.L.C.	DBA: CVS/PHARMACY # 08075	27435 FORD RD.	GARDEN CITY	MI	48135	10/15/2018	01/01/2019		01/01/2019
Contract Detail	WOODWARD DETROIT CVS, L.L.C.	DBA: CVS/PHARMACY # 08232	3575 WEST ROAD	TRENTON	MI	48183	10/15/2018	01/01/2019		01/01/2019
Contract Detail	WOODWARD DETROIT CVS, L.L.C.	DBA: CVS/PHARMACY # 08094	1935 CAMPBELL	DETROIT	MI	48209	10/15/2018	01/01/2019		01/01/2019
Contract Detail	WOODWARD DETROIT CVS, L.L.C.	DBA: CVS/PHARMACY # 08010	31411 CHERRY HILL	WESTLAND	MI	48186	10/15/2018	01/01/2019		01/01/2019
Contract Detail	WOODWARD DETROIT CVS, L.L.C.	DBA: CVS/PHARMACY # 08104	19851 W. WARREN	DETROIT	MI	48228	10/15/2018	01/01/2019		01/01/2019
Contract Detail	WOODWARD DETROIT CVS, L.L.C.	DBA: CVS/PHARMACY # 08001	15325 MICHIGAN AVE	DEARBORN	MI	48126	10/15/2018	01/01/2019		01/01/2019
Contract Detail	WOODWARD DETROIT CVS, L.L.C.	DBA: CVS/PHARMACY # 08141	6862 MICHIGAN AVE	DETROIT	MI	48210	10/15/2018	01/01/2019		01/01/2019
Contract Detail	WOODWARD DETROIT CVS, L.L.C.	DBA: CVS/PHARMACY # 08005	23115 MICHIGAN AVE	DEARBORN	MI	48124	10/15/2018	01/01/2019		01/01/2019
Contract Detail	WOODWARD DETROIT CVS, L.L.C.	DBA: CVS/PHARMACY # 08152	22060 OUTER DR	DEARBORN	MI	48124-3932	10/15/2018	01/01/2019		01/01/2019
Contract Detail	WOODWARD DETROIT CVS, L.L.C.	DBA: CVS/PHARMACY # 08072	27000 TELEGRAPH RD	FLAT ROCK	MI	48134-1657	10/15/2018	01/01/2019		01/01/2019
Contract Detail	WOODWARD DETROIT CVS, L.L.C.	DBA: CVS/PHARMACY # 08055	18340 ALLEN ROAD	MELVINDALE	MI	48122	10/15/2018	01/01/2019		01/01/2019
Contract Detail	WOODWARD DETROIT CVS, L.L.C.	DBA: CVS/PHARMACY # 08051	22000 ECORSE RD.	TAYLOR	MI	48180	10/15/2018	01/01/2019		01/01/2019
Contract Detail	WOODWARD DETROIT CVS, L.L.C.	DBA: CVS/PHARMACY # 08064	1625 KING RD.	TRENTON	MI	48183	10/15/2018	01/01/2019		01/01/2019
Contract Detail	WOODWARD DETROIT CVS, L.L.C.	DBA: CVS/PHARMACY # 08029	2025 FORT STREET	WYANDOTTE	MI	48192	10/15/2018	01/01/2019		01/01/2019
Contract Detail	WOODWARD DETROIT CVS, L.L.C.	CVS PHARMACY # 17126	3100 FAIRLANE DR	ALLEN PARK	MI	48101	04/14/2019	07/01/2019		07/01/2019
Contract Detail	WOODWARD DETROIT CVS, L.L.C.	DBA: CVS/PHARMACY # 08007	27350 PLYMOUTH ROAD	REDFORD	MI	48239	04/14/2019	07/01/2019		07/01/2019
Contract Detail	WOODWARD DETROIT CVS, L.L.C.	DBA: CVS/PHARMACY # 08128	2701 S TELEGRAPH RD	DEARBORN	MI	48124-3276	04/14/2019	07/01/2019		07/01/2019
Contract Detail	WOODWARD DETROIT CVS, L.L.C.	DBA: CVS/PHARMACY # 08042	10915 BELLEVILLE RD	VAN BUREN TWP	MI	48111	04/14/2019	07/01/2019		07/01/2019
Contract Detail	WOODWARD DETROIT CVS, L.L.C.	DBA: CVS/PHARMACY # 08028	11125 ALLEN ROAD	SOUTHGATE	MI	48195	04/14/2019	07/01/2019		07/01/2019
Contract Detail	WOODWARD DETROIT CVS, L.L.C.	CVS PHARMACY # 16086	15901 FORD RD	DEARBORN	MI	48126	04/14/2019	07/01/2019		07/01/2019
Contract Detail	WOODWARD DETROIT CVS, L.L.C.	DBA: CVS/PHARMACY # 08125	26101 EUREKA RD.	TAYLOR	MI	48180	01/17/2020	04/01/2020		04/01/2020
Contract Detail	WOODWARD DETROIT CVS, L.L.C.	DBA: CVS/PHARMACY # 08114	15300 EUREKA RD.	SOUTHGATE	MI	48195	01/17/2020	04/01/2020		04/01/2020
Contract Detail	WOODWARD DETROIT CVS, L.L.C.	DBA: CVS/PHARMACY # 08132	4101 TELEGRAPH RD.	BLOOMFIELD HILLS	MI	48302	01/17/2020	04/01/2020		04/01/2020
Contract Detail	WOODWARD DETROIT CVS, L.L.C.	CVS PHARMACY # 17307	29451 PLYMOUTH RD	LIVONIA	MI	48150	01/17/2020	04/01/2020		04/01/2020
Contract Detail	WOODWARD DETROIT CVS, L.L.C.	DBA: CVS/PHARMACY #8233	23881 GREENFIELD RD	SOUTHFIELD	MI	48075	01/17/2020	04/01/2020		04/01/2020
Contract Detail	WOODWARD DETROIT CVS, L.L.C.	DBA: CVS/PHARMACY # 00927	37530 CHERRY HILL RD.	WESTLAND	MI	48185	01/17/2020	04/01/2020		04/01/2020
Contract Detail	WOODWARD DETROIT CVS, L.L.C.	DBA: CVS/PHARMACY # 08017	27365 CHERRY HILL	INKSTER	MI	48141	01/17/2020	04/01/2020		04/01/2020
Contract Detail	WOODWARD DETROIT CVS, L.L.C.	DBA: CVS/PHARMACY # 08059	1750 S. WAYNE RD.	WESTLAND	MI	48186	01/17/2020	04/01/2020		04/01/2020
Contract Detail	WOODWARD DETROIT CVS, L.L.C.	DBA: CVS/PHARMACY # 00211	18900 TELEGRAPH RD.	BROWNSTOWN	MI	48174	01/17/2020	04/01/2020		04/01/2020
Contract Detail	WOODWARD DETROIT CVS, L.L.C.	DBA: CVS/PHARMACY # 08056	8710 N. BEECH DALY	DEARBORN HEIGHTS	MI	48127	01/17/2020	04/01/2020		04/01/2020
Contract Detail	WOODWARD DETROIT CVS, L.L.C.	DBA: CVS/PHARMACY # 08175	18600 LIVERNOIS	DETROIT	MI	48221	01/17/2020	04/01/2020		04/01/2020
Contract Detail	WOODWARD DETROIT CVS, L.L.C.	DBA: CVS/PHARMACY # 08269	13580 GRAND RIVER AVE.	DETROIT	MI	48227	07/16/2020	10/01/2020		10/01/2020
Contract Detail	WOODWARD DETROIT CVS, L.L.C.	DBA: CVS/PHARMACY # 08008	7291 N MIDDLEBELT ROAD	WESTLAND	MI	48185	07/16/2020	10/01/2020		10/01/2020
Contract Detail	WOODWARD DETROIT CVS, L.L.C.	DBA: CVS/PHARMACY # 08077	40900 ANN ARBOR RD., EAST	PLYMOUTH	MI	48170	07/16/2020	10/01/2020		10/01/2020
Contract Detail	WOODWARD DETROIT CVS, L.L.C.	DBA: CVS/PHARMACY # 08225	1791 S HAGGERTY RD	CANTON	MI	48188	07/16/2020	10/01/2020		10/01/2020
Contract Detail	WOODWARD DETROIT CVS, L.L.C.	DBA: CVS/PHARMACY # 08065	6501 N. WAYNE RD.	WESTLAND	MI	48185	07/16/2020	10/01/2020		10/01/2020
Contract Detail	WOODWARD DETROIT CVS, L.L.C.	DBA: CVS/PHARMACY # 08138	2950 S NEWBURGH RD	WAYNE	MI	48184	10/12/2021	01/01/2022		01/01/2022
Contract Detail	WOODWARD DETROIT CVS, L.L.C.	DBA: CVS/PHARMACY # 08015	29500 FIVE MILE RD.	LIVONIA	MI	48154	10/12/2021	01/01/2022		01/01/2022
Contract Detail	WOODWARD DETROIT CVS, L.L.C.	DBA: CVS/PHARMACY # 08212	31501 JOY ROAD	WESTLAND	MI	48185	10/12/2021	01/01/2022		01/01/2022
Contract Detail	WOODWARD DETROIT CVS, LLC	DBA: CVS/PHARMACY # 08221	25762 VAN BORN	DEARBORN HEIGHTS	MI	48125	10/15/2018	01/01/2019		01/01/2019
Contract Detail	WOODWARD DETROIT CVS, LLC	DBA: CVS/PHARMACY # 08211	31450 VAN BORN	WAYNE	MI	48184	10/15/2018	01/01/2019		01/01/2019
Contract Detail	WOODWARD DETROIT CVS, LLC	DBA: CVS/PHARMACY # 08213	13545 EUREKA ROAD	SOUTHGATE	MI	48195	04/14/2019	07/01/2019		07/01/2019
Contract Detail	WOODWARD DETROIT CVS, LLC	DBA: CVS/PHARMACY # 08181	15240 SOUTHFIELD	ALLEN PARK	MI	48101	04/14/2019	07/01/2019		07/01/2019
Contract Detail	WOODWARD DETROIT CVS, LLC	DBA: CVS/PHARMACY # 08231	350 E WARREN AVE	DETROIT	MI	48201	04/14/2019	07/01/2019		07/01/2019
Contract Detail	WOODWARD DETROIT CVS, LLC	DBA: CVS/PHARMACY # 08218	22300 GODDARD	TAYLOR	MI	48180	04/14/2019	07/01/2019		07/01/2019
Contract Detail	WOODWARD DETROIT CVS, LLC	DBA: CVS/PHARMACY # 08190	45300 CHERRY HILL RD.	CANTON	MI	48187	01/17/2020	04/01/2020		04/01/2020
Contract Detail	WOODWARD DETROIT CVS, LLC	DBA: CVS/PHARMACY # 08167	7269 N. CANTON CENTER RD	CANTON	MI	48187	07/16/2020	10/01/2020		10/01/2020
Contract Detail	WOODWARD DETROIT CVS, LLC	DBA: CVS/PHARMACY # 08159	15640 W. WARREN	DETROIT	MI	48228	07/16/2020	10/01/2020	08/01/2020	08/31/2020
Contract Detail	WOODWARD DETROIT CVS, LLC	DBA: CVS/PHARMACY # 08186	18500 GRAND RIVER	DETROIT	MI	48223	07/16/2020	10/01/2020		10/01/2020
Contract Detail	WOODWARD DETROIT CVS, LLC	DBA: CVS/PHARMACY # 08160	23800 WEST RD.	BROWNSTOWN TWP	MI	48183	07/16/2020	10/01/2020		10/01/2020

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH230020A	Child	DSH	OAKWOOD HOSPITAL & MEDICAL CENTER (OHMC)	Oakwood Breast Care Center	18100 Oakwood Blvd	Dearborn	MI	Terminated
DSH230020B	Child	DSH	OAKWOOD HOSPITAL & MEDICAL CENTER (OHMC)	Outpatient Imaging Center	Oakwood Medical Park	Dearborn	MI	Terminated
DSH230020C	Child	DSH	OAKWOOD HOSPITAL & MEDICAL CENTER (OHMC)	Oakwood Imaging West	25045 Ford Rd	Dearborn	MI	Terminated
DSH230020D	Child	DSH	OAKWOOD HOSPITAL & MEDICAL CENTER (OHMC)	Oakwood Imaging Dearborn Town Center	4700 Schaefer Rd	Dearborn	MI	Terminated
DSH230020E	Child	DSH	Oakwood Healthcare, Inc. d/b/a Corewell Health Dearborn Hospital	Corewell Health Dearborn Hospital Hematology & Oncology - 19725 Allen Rd	19725 Allen Rd	Brownstown	MI	Active
DSH230020F	Child	DSH	Oakwood Healthcare, Inc. d/b/a Beaumont Hospital - Dearborn	Oakwood Hematology Oncology Center	4900 Mercury Drive	Dearborn	MI	Terminated
DSH230020H	Child	DSH	Oakwood Healthcare, Inc. d/b/a Corewell Health Dearborn Hospital	Corewell Health Dearborn Hospital Center for Exceptional Families - 18501 Rotunda Dr	18501 Rotunda Dr.	Dearborn	MI	Active
DSH230020J	Child	DSH	Oakwood Healthcare, Inc. d/b/a Beaumont Hospital - Dearborn	Beaumont Infectious Disease-Dearborn	18181 Oakwood Blvd	Dearborn	MI	Terminated
DSH230020K	Child	DSH	Oakwood Healthcare, Inc. d/b/a Corewell Health Dearborn Hospital	Corewell Health Dearborn Hospital Specialty Services Cardiology - 22060 Beech St	22060 BEECH ST 200	DEARBORN	MI	Active
DSH230020L	Child	DSH	Oakwood Healthcare, Inc. d/b/a Corewell Health Dearborn Hospital	Corewell Health Dearborn Hospital Health Center - Commons Dearborn	16351 ROTUNDA DR 168	DEARBORN	MI	Active
DSH230020M	Child	DSH	Oakwood Healthcare, Inc. d/b/a Corewell Health Dearborn Hospital	Corewell Health Dearborn Hospital Internal Medicine - 17000 Hubbard Drive	17000 Hubbard Drive	Dearborn	MI	Active
DSH230020N	Child	DSH	Oakwood Healthcare, Inc. d/b/a Beaumont Hospital - Dearborn	Beaumont Pediatrics-Dearborn	18181 OAKWOOD BLVD G101	DEARBORN	MI	Terminated
DSH230020P	Child	DSH	Oakwood Healthcare, Inc. d/b/a Corewell Health Dearborn Hospital	Corewell Health Internal Medicine - 4700 Schaefer Rd	4700 SCHAEFER RD 240	DEARBORN	MI	Active
DSH230020Q	Child	DSH	Oakwood Healthcare, Inc. d/b/a Beaumont Hospital - Dearborn	Beaumont Center for Hematology & Oncology - Dearborn/Dr. Signori's Office - Hematology/Oncology	4900 Mercury Drive	Dearborn	MI	Terminated
DSH230020R	Child	DSH	Oakwood Healthcare, Inc. d/b/a Beaumont Hospital - Dearborn	Beaumont Rheumatology - Dearborn	4700 Schaefer Rd	Dearborn	MI	Terminated
DSH230020S	Child	DSH	Oakwood Healthcare, Inc. d/b/a Corewell Health Dearborn Hospital	Corewell Health Dearborn Hospital Obstetrics & Gynecology - 4700 Schaefer Rd	4700 Schaefer Rd	Dearborn	MI	Active
DSH230020T	Child	DSH	Oakwood Healthcare, Inc. d/b/a Corewell Health Dearborn Hospital	Corewell Health Dearborn Hospital General and Bariatric Surgery - 18181 Oakwood Blvd	18181 Oakwood Blvd	Dearborn	MI	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Profile Change Request	Dalal, Hardik SVP, Finance CHW Corewell Health 3127710810	Dalal, Hardik SVP, Finance & System-wide Pharmacy Finance Corewell Health 3127710810	2/24/2025 6:26 AM
Details	Last Recertification Date	Update	Recertification	8/14/2023 2:58:36 PM	9/6/2024 11:17:55 AM	9/6/2024 11:17 AM
Details	Entity Name	Update	Recertification	Oakwood Healthcare, Inc. d/b/a Beaumont Hospital - Dearborn	Oakwood Healthcare, Inc. d/b/a Corewell Health Dearborn Hospital	9/6/2024 11:17 AM
Contacts	Primary Contact	Update	Profile Change Request	Schaible, Thomas 340B Pharmacy Manager Corewell Health 9475221169	Schaible, Thomas Mgr, Pharmacy CHE Corewell Health 9475221169	1/30/2024 8:36 AM
Contacts	Primary Contact	Update	PC Change Request	Desai, Neha Director, Pharmacy Oakwood 3135937255-37268	Schaible, Thomas 340B Pharmacy Manager Corewell Health 9475221169	1/9/2024 1:32 PM
Contacts	Authorizing Official	Update	AO Change Request	Susick, Nancy Ann COO Beaumont Health 9475223349	Dalal, Hardik SVP, Finance CHW Corewell Health 3127710810	12/13/2023 7:55 AM
Details	Last Recertification Date	Update	Recertification	8/31/2022 2:33:11 PM	8/14/2023 2:58:36 PM	8/14/2023 2:58 PM
Contacts	Authorizing Official	Update	AO Change Request	Odom, Lee Ann President, Shared Services Beaumont Health 9475222653	Susick, Nancy Ann COO Beaumont Health 9475223349	10/17/2022 10:24 AM
Details	Last Recertification Date	Update	Recertification	9/1/2021 12:10:07 PM	8/31/2022 2:33:11 PM	8/31/2022 2:33 PM
Details	Last Recertification Date	Update	Recertification	9/1/2020 9:11:53 AM	9/1/2021 12:10:07 PM	9/1/2021 12:10 PM
Contacts	Authorizing Official	Update	AO Change Request	Wilson, Carolyn Chief Operating Officer Beaumont Health 9475223338	Odom, Lee Ann President, Shared Services Beaumont Health 9475222653	8/20/2021 3:33 PM
Medicaid Billing	NPI: State	Update	Recertification		MI	9/1/2020 9:11 AM
Details	Last Recertification Date	Update	Recertification	9/10/2019 11:28:55 AM	9/1/2020 9:11:53 AM	9/1/2020 9:11 AM
Contacts	Authorizing Official	Update	Profile Change Request	Wilson, Carolyn Chief Operating Officer Beaumont Health 2482133338	Wilson, Carolyn Chief Operating Officer Beaumont Health 9475223338	6/2/2020 8:31 AM
Details	Entity Name	Update	Change Request	OAKWOOD HOSPITAL & MEDICAL CENTER (OHMC)	Oakwood Healthcare, Inc. d/b/a Beaumont Hospital - Dearborn	12/4/2019 9:00 AM
Details	Last Recertification Date	Update	Recertification	8/16/2018 10:36:03 AM	9/10/2019 11:28:55 AM	9/10/2019 11:28 AM
Contacts	Primary Contact	Update	Recertification	Desai, Neha Director, Pharmacy Oakwood 3135937255	Desai, Neha Director, Pharmacy Oakwood 3135937255-37268	8/28/2019 2:14 PM
Details	Last Recertification Date	Update	Recertification	11/29/2017 3:51:07 PM	8/16/2018 10:36:03 AM	8/16/2018 10:36 AM
Details	Last Recertification Date	Update	Recertification	8/31/2016 12:00:00 AM	11/29/2017 3:51:07 PM	11/29/2017 3:51 PM
Contacts	Primary Contact	Update		Desai, Neha Director, Pharmacy 3135937255	Desai, Neha Director, Pharmacy Oakwood 3135937255	10/12/2017 3:44 PM
Contacts	Authorizing Official	Update		Wilson, Carolyn Chief Operating Officer 2482133338	Wilson, Carolyn Chief Operating Officer Beaumont Health 2482133338	10/12/2017 10:32 AM
Contacts	Authorizing Official	Update		Smith, Kelly SVP OHI Division President OHMC 3139825948	Wilson, Carolyn Chief Operating Officer 2482133338	7/3/2017 1:01 PM
Addresses	Main Address	Insert			18101 OAKWOOD BOULEVARD DEARBORN, MI 48124	3/13/2017 5:28 PM
Contacts	Primary Contact	Update		Batkie, David Director of Pharmacy 3135937248	Desai, Neha Director, Pharmacy 3135937255	3/13/2017 5:28 PM
Medicaid Billing	NPI: Number	Insert			1740230119	3/13/2017 5:27 PM
Details	Last Recertification Date	Update		8/28/2015 12:00:00 AM	8/31/2016 12:00:00 AM	8/31/2016 3:53 PM
Contacts	Authorizing Official	Insert			Smith, Kelly SVP OHI Division President OHMC 3139825948	6/10/2016 10:48 AM
Contacts	Primary Contact	Update		MCCALL, SCOTT MANAGER, PHARMACY PROFESSIONAL SERVICES 3135937255	Batkie, David Director of Pharmacy 3135937248	8/28/2015 3:32 PM
Details	Last Recertification Date	Update		9/3/2014 12:00:00 AM	8/28/2015 12:00:00 AM	8/28/2015 3:32 PM
Details	Last Recertification Date	Update		8/30/2013 12:00:00 AM	9/3/2014 12:00:00 AM	9/3/2014 12:51 PM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	8/30/2013 12:00:00 AM	8/30/2013 1:08 PM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	5/16/2012 7:47 AM
Contacts	Primary Contact	Insert			MCCALL, SCOTT MANAGER, PHARMACY PROFESSIONAL SERVICES 3135937255	10/28/2011 2:57 PM
Details	Last Recertification Date	Insert				7/6/2011 5:28 PM
Details	Grant Number	Insert				7/6/2011 5:28 PM
Details	340B ID	Insert			DSH230020	7/6/2011 5:28 PM
Details	Is Authorizing Official EHB Data	Insert				7/6/2011 5:28 PM
Dates	Last Date That 340B Drugs Purchased	Insert				7/6/2011 5:28 PM
Details	Medicare Provider Number	Insert			230020	7/6/2011 5:28 PM
Details	Entity Name	Insert			OAKWOOD HOSPITAL & MEDICAL CENTER (OHMC)	7/6/2011 5:28 PM
Details	Program Code	Insert			DSH	7/6/2011 5:28 PM
Details	Entity Subname	Insert				7/6/2011 5:28 PM
Dates	Participating Approval Date	Insert			6/5/2006 12:00:00 AM	7/6/2011 5:28 PM
Details	State	Insert			Active	7/6/2011 5:28 PM
Dates	Registration Date	Insert			6/1/2006 12:00:00 AM	7/6/2011 5:28 PM
Dates	Signed By Date	Insert			5/25/2006 12:00:00 AM	7/6/2011 5:28 PM
Dates	Start Date	Insert			7/1/2006 12:00:00 AM	7/6/2011 5:28 PM
Terminations	Termination Comments	Insert				7/6/2011 5:28 PM
Terminations	Termination Date	Insert				7/6/2011 5:28 PM
Terminations	Termination Effective Date	Insert				7/6/2011 5:28 PM
Terminations	Termination Reason	Insert				7/6/2011 5:28 PM
Details	Comments Public	Insert			6/27/2011 - DOC. RECD. TO CONFIRM NON-PROFIT STATUS 3/24/2010- DOC. RECD. TO CONFIRM ELIG. OWNERSHIP TYPE	7/6/2011 5:28 PM
Details	Comments Public	Insert			6/27/2011 - DOC. RECD. TO CONFIRM NON-PROFIT STATUS 3/24/2010- DOC. RECD. TO CONFIRM ELIG. OWNERSHIP TYPE	7/6/2011 5:28 PM