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PALM PHARMACY
DSH230046 UNIVERSITY OF MICHIGAN HOSPITALS AND HEALTH CENTERS
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Covered Entity Details
Entity Name
UNIVERSITY OF MICHIGAN HOSPITALS AND HEALTH CENTERS
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230046
Entity Address
1500 EAST MEDICAL CENTER DRIVE
ANN ARBOR, MI 48109
Medicare Provider Number
230046
Participating Start Date
1/1/2004
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
PALM PHARMACY
Pharmacy Address
6650 GREENFIELD RD
DEARBORN, MI 48126
Pharmacy Comments
Contract Details
Approval Date
1/14/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/14/2019
Agreement registered in error
Contacts
Covered Entity Signing Official
Jeffrey S. Desmond, Chief Medical Officer
(734) 936-5814
Contract Pharmacy Representative
Palm Good Neighbor Pharmacy
Ali El-Khatib, Pharmacist In Charge
(734) 722-8774
Signed By Date
1/14/2019
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