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HACKLEY PROFESSIONAL PHARMACY, INC
CAH231320-00 Trinity Health Shelby Hospital
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Covered Entity Details
Entity Name
Trinity Health Shelby Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH231320-00
Entity Address
72 SOUTH STATE STREET
SHELBY, MI 49455
Medicare Provider Number
231320
Participating Start Date
8/9/2010
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
HACKLEY PROFESSIONAL PHARMACY, INC
Pharmacy Address
DBA - TRINITY HEALTH PHARMACY - MUSKEGON
1500 E SHERMAN BLVD
GARDEN LEVEL P-200
MUSKEGON, MI 49444
Pharmacy Comments
Contract Details
Approval Date
4/12/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
John Thomas Foss, Vice President of Operations - Lakeshore Campus
(231) 861-3029
Contract Pharmacy Representative
Mercy Health
Kristi Nagengast, Vice President of Finance
(231) 672-3802
Signed By Date
4/12/2021
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