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THE KROGER CO OF MICHIGAN
DSH230020 Oakwood Healthcare, Inc. d/b/a Corewell Health Dearborn Hospital
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Covered Entity Details
Entity Name
Oakwood Healthcare, Inc. d/b/a Corewell Health Dearborn Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230020
Entity Address
18101 OAKWOOD BOULEVARD
DEARBORN, MI 48124
Medicare Provider Number
230020
Participating Start Date
7/1/2006
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
THE KROGER CO OF MICHIGAN
Pharmacy Address
23303 MICHIGAN AVENUE
DEARBORN, MI 48124
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
7/5/2024
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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