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HOMETOWN PHARMACY #53 - MUSKEGON
DSH230066 Trinity Health Muskegon Hospital
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Covered Entity Details
Entity Name
Trinity Health Muskegon Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230066
Entity Address
1500 E. Sherman Blvd.
Muskegon, MI 49444
Medicare Provider Number
230066
Participating Start Date
1/1/2005
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
HOMETOWN PHARMACY #53 - MUSKEGON
Pharmacy Address
5866 HARVEY ST
MUSKEGON, MI 49444
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
Kristi Nagengast, Vice President of Finance
(231) 672-3802
Contract Pharmacy Representative
Hometown Pharmacy Inc.
Jim Grice, Vice President
(231) 861-6900
Signed By Date
4/15/2019
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