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THE KROGER CO OF MI #693
DSH230270 OAKWOOD HEALTHCARE INC. dba Corewell Health Taylor Hospital
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Covered Entity Details
Entity Name
OAKWOOD HEALTHCARE INC. dba Corewell Health Taylor Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230270
Entity Address
10000 Telegraph Road
TAYLOR, MI 48180
Medicare Provider Number
230270
Participating Start Date
10/1/2015
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
THE KROGER CO OF MI #693
Pharmacy Address
2060 DIX AVENUE
LINCOLN PARK, MI 48146
Pharmacy Comments
Contract Details
Approval Date
4/15/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/4/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Carolyn Wilson, Chief Operating Officer
(947) 522-3338
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
4/15/2019
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