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WOODWARD DETROIT CVS, L.L.C.
DSH230151 Botsford General Hospital d/b/a Corewell Health Farmington Hills Hospital
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Covered Entity Details
Entity Name
Botsford General Hospital d/b/a Corewell Health Farmington Hills Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230151
Entity Address
28050 GRAND RIVER AVE
FARMINGTON HILLS, MI 48336
Medicare Provider Number
230151
Participating Start Date
4/1/2015
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
WOODWARD DETROIT CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 01150
30900 WOODWARD
ROYAL OAK, MI 48073
Pharmacy Comments
Contract Details
Approval Date
7/17/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Carolyn Wilson, Chief Operating Officer
(947) 522-3338
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/17/2018
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