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MEIJER STORES LIMITED PARTNERSHIP
CHC02456-00 WINDROSE HEALTH NETWORK, INC.
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Covered Entity Details
Entity Name
WINDROSE HEALTH NETWORK, INC.
Subdivision Name
Windrose Health Network - Trafalgar
Type
HRSA-Funded Health Center
340B ID
CHC02456-00
Entity Address
14 Trafalgar Sq
Trafalgar, IN 46181-9515
Grant Number
H80CS02456
Participating Start Date
10/1/2016
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
MEIJER STORES LIMITED PARTNERSHIP
Pharmacy Address
D/B/A MEIJER PHARMACY #463
1515 PROFIT DR.
FORT WAYNE, IN 46808
Pharmacy Comments
Contract Details
Approval Date
10/1/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Scott K Rollett, CEO
(317) 739-4895 Ext: 2401
Contract Pharmacy Representative
Meijer
Kevin Hurn, Dir, Pharmacy Procurement and New Business
(616) 791-5185
Signed By Date
10/1/2019
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