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MEIJER STORES LIMITED PARTNERSHIP
CAH231339-00 Corewell Health Pennock Hospital
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Covered Entity Details
Entity Name
Corewell Health Pennock Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH231339-00
Entity Address
1009 west Green Street
Hastings, MI 49058
Medicare Provider Number
231339
Participating Start Date
7/1/2019
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
MEIJER STORES LIMITED PARTNERSHIP
Pharmacy Address
D/B/A MEIJER PHARMACY #463
1515 PROFIT DR.
FORT WAYNE, IN 46808
Pharmacy Comments
Contract Details
Approval Date
7/15/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael King, Controller
(269) 948-3122
Contract Pharmacy Representative
Meijer
Kevin Hurn, Dir, Pharmacy Procurement and New Business
(616) 791-5185
Signed By Date
7/15/2021
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