Contract Pharmacy Details

GENOA HEALTHCARE LLC
DSH230046 UNIVERSITY OF MICHIGAN HOSPITALS AND HEALTH CENTERS

Covered Entity Details

Entity Name

UNIVERSITY OF MICHIGAN HOSPITALS AND HEALTH CENTERS

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH230046

Entity Address

1500 EAST MEDICAL CENTER DRIVE
ANN ARBOR, MI 48109

Medicare Provider Number

230046

Participating Start Date

1/1/2004

Last Recertification Date

8/20/2024

Pharmacy Details

Pharmacy Name

GENOA HEALTHCARE LLC

Pharmacy Address

50680 CORPORATE DRIVE
SUITE #2
SHELBY TOWNSHIP, MI 48315

Pharmacy Comments

Contract Details

Approval Date

4/15/2021

Contract Begin Date

4/19/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/1/2022
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Jeffrey S. Desmond, Chief Medical Officer
(734) 936-5814

Contract Pharmacy Representative

Avella/BriovaRx
Paul Leschinert, National Account Manager,340B Sales
(847) 409-0200

Signed By Date

4/15/2021

340B Drug Pricing Program Database