Contract Pharmacy Details

MEIJER INC #201
RRC230208-00 Sparrow Carson Hospital

Covered Entity Details

Entity Name

Sparrow Carson Hospital

Subdivision Name

Type

Rural Referral Center

340B ID

RRC230208-00

Entity Address

406 EAST ELM STREET
CARSON CITY, MI 48811

Medicare Provider Number

230208

Participating Start Date

10/1/2019

Last Recertification Date

Entity Termination Date

10/1/2020

Pharmacy Details

Pharmacy Name

MEIJER INC #201

Pharmacy Address

606 S. GREENVILLE WEST DRIVE
GREENVILLE, MI 48838

Pharmacy Comments

Contract Details

Approval Date

9/13/2019

Contract Begin Date

10/1/2019

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/1/2020
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Mark Brisboe, Chief Financial Officer
(616) 523-1702

Contract Pharmacy Representative

Meijer
Jeff Romano, Hospital Programs
(616) 791-3171

Signed By Date

9/13/2019

340B Drug Pricing Program Database