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WOODWARD DETROIT CVS, L.L.C.
CHC29011-00 PACKARD HEALTH, INC.
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Covered Entity Details
Entity Name
PACKARD HEALTH, INC.
Subdivision Name
Packard Health Carpenter
Type
HRSA-Funded Health Center
340B ID
CHC29011-00
Entity Address
2650 Carpenter Road
Ann Arbor, MI 48108
Grant Number
H80CS29011
Participating Start Date
4/1/2016
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
WOODWARD DETROIT CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05741
7488 VILLAGE CENTER DR.
WHITMORE LAKE, MI 48189
Pharmacy Comments
Contract Details
Approval Date
1/8/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mark Jacoby, CFO
(734) 971-1073
Contract Pharmacy Representative
CVS
Gabrielle Lagana, Implementation Consultant
(212) 419-4049
Signed By Date
1/8/2020
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