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MEDCART SPECIALTY PHARMACY
HV00105A Wayne State University
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Covered Entity Details
Entity Name
Wayne State University
Subdivision Name
Internal Medicine
Type
Ryan White Part C
340B ID
HV00105A
Entity Address
656 West Kirby Street
Detroit, MI 48201-2119
Grant Number
H76HA00105
Participating Start Date
1/1/2017
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
MEDCART SPECIALTY PHARMACY
Pharmacy Address
32131 INDUSTRIAL ROAD
LIVONIA, MI 48150
Pharmacy Comments
Contract Details
Approval Date
4/14/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jonathan A. Cohn, Program Director
(313) 577-3238
Contract Pharmacy Representative
Albertsons
Kathy Giannakopoulos, 340b contractor
(208) 395-3906
Signed By Date
4/14/2020
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