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MEIJER SPECIALTY PHARMACY
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
MEIJER SPECIALTY PHARMACY
Pharmacy Address
8455 HAGGERTY ROAD
BELLEVILLE, MI 48111
Pharmacy Comments
Contract Details
Approval Date
7/12/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mark Pawlak, President
(616) 392-5141
Contract Pharmacy Representative
Meijer
Kevin Hurn, Dir, Pharmacy Procurement and New Business
(616) 791-5185
Signed By Date
7/12/2021
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