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TRINITY HEALTH OAKLAND PHARMACY
RRC230029-00 ST. JOSEPH MERCY HOSPITAL-OAKLAND
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Covered Entity Details
Entity Name
ST. JOSEPH MERCY HOSPITAL-OAKLAND
Subdivision Name
Type
Rural Referral Center
340B ID
RRC230029-00
Entity Address
44405 WOODWARD AVENUE
PONTIAC, MI 48341
Medicare Provider Number
230029
Participating Start Date
2/2/2021
Last Recertification Date
8/25/2021
Entity Termination Date
7/1/2022
Pharmacy Details
Pharmacy Name
TRINITY HEALTH OAKLAND PHARMACY
Pharmacy Address
44405 WOODWARD AVE
PONTIAC, MI 48341
Pharmacy Comments
Contract Details
Approval Date
1/7/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/2/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Michael Gusho, Regional Chief Financial Officer
(248) 858-6174
Contract Pharmacy Representative
Trinity Health Oakland Hospital
Phillip J. Wein, Director of Pharmacy
(248) 858-3053
Signed By Date
1/7/2019
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