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PDS-I MICHIGAN, INC.
DSH230230 EDWARD W SPARROW HOSPITAL ASSOCIATION
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Covered Entity Details
Entity Name
EDWARD W SPARROW HOSPITAL ASSOCIATION
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230230
Entity Address
1215 E MICHIGAN AVE
LANSING, MI 48912
Medicare Provider Number
230230
Participating Start Date
10/1/2004
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
PDS-I MICHIGAN, INC.
Pharmacy Address
RITE AID #4326
431 WEST LINCOLN HIGHWAY
IONIA, MI 48846
Pharmacy Comments
Contract Details
Approval Date
4/10/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/3/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
PAULA M. REICHLE, SR VP AND CFO
(517) 364-5400
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President, Managed Care
(717) 975-5968
Signed By Date
4/10/2019
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