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CROWN 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
CROWN SPECIALTY PHARMACY
Pharmacy Address
CROWN PHARMACY
24401 PLYMOUTH RD
REDFORD, MI 48239-1616
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
Crown Pharmacy LLC
Ali Fakih, 340B Contact
(313) 532-3784
Signed By Date
4/14/2020
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