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ALEXANDER'S DRUG STORE
DSH230072 HOLLAND HOSPITAL
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Covered Entity Details
Entity Name
HOLLAND HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230072
Entity Address
602 MICHIGAN AVENUE
HOLLAND, MI 49423-4999
Medicare Provider Number
230072
Participating Start Date
1/1/2012
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
ALEXANDER'S DRUG STORE
Pharmacy Address
211 E MAIN ST
FENNVILLE, MI 49408
Pharmacy Comments
Contract Details
Approval Date
4/10/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
TERRY L. STEELE, CFO
(616) 392-5141
Contract Pharmacy Representative
Saugatuck Drug
Daniel M Alexander, Pharmacist
(269) 857-2300
Signed By Date
4/10/2020
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