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MEIJER DISTRIBUTION INC #90
CHC28353-00 LifeSpring Inc.
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Covered Entity Details
Entity Name
LifeSpring Inc.
Subdivision Name
LifeSpring Community Medical Services
Type
HRSA-Funded Health Center
340B ID
CHC28353-00
Entity Address
1036 SHARON DR
JEFFERSONVILLE, IN 47130-4522
Grant Number
H80CS28353
Participating Start Date
10/1/2015
Last Recertification Date
3/12/2025
Pharmacy Details
Pharmacy Name
MEIJER DISTRIBUTION INC #90
Pharmacy Address
2721 WALKER AVE NW
GRAND RAPIDS, MI 49544
Pharmacy Comments
Distribution Center
Contract Details
Approval Date
10/4/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Beth Keeney, President/CEO
(812) 206-1362
Contract Pharmacy Representative
Meijer
Katy Diaz, Pharmacy Business Associate
(616) 791-3127
Signed By Date
10/4/2019
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