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HOMETOWN PHARMACY, INC.
CAH231320-00 Trinity Health Shelby Hospital
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Covered Entity Details
Entity Name
Trinity Health Shelby Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH231320-00
Entity Address
72 SOUTH STATE STREET
SHELBY, MI 49455
Medicare Provider Number
231320
Participating Start Date
8/9/2010
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
HOMETOWN PHARMACY, INC.
Pharmacy Address
DBA HOMETOWN PHARMACY #21 - SHELBY
178 N MICHIGAN AVE
SHELBY, MI 49455-1028
Pharmacy Comments
Contract Details
Approval Date
4/15/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
John Thomas Foss, Vice President of Operations - Lakeshore Campus
(231) 861-3029
Contract Pharmacy Representative
Hometown Pharmacy Inc.
Jim Grice, Vice President
(231) 861-6900
Signed By Date
4/15/2019
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