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MEIJER INC #63
DSH230089 WILLIAM BEAUMONT HOSPITAL D/B/A Corewell Health Beaumont Grosse Pointe Hospital
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Covered Entity Details
Entity Name
WILLIAM BEAUMONT HOSPITAL D/B/A Corewell Health Beaumont Grosse Pointe Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230089
Entity Address
468 CADIEUX ROAD
GROSSE POINTE, MI 48230
Medicare Provider Number
230089
Participating Start Date
1/1/2017
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
MEIJER INC #63
Pharmacy Address
30800 LITTLE MACK RD
ROSEVILLE, MI 48066
Pharmacy Comments
Contract Details
Approval Date
1/15/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/4/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Carolyn Wilson, Chief Operating Officer
(947) 522-3338
Contract Pharmacy Representative
Meijer
Kevin Hurn, Dir, Pharmacy Procurement and New Business
(616) 791-5185
Signed By Date
1/15/2019
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