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MEIJER PHARMACY #310
SCH230110-00 Corewell Health Ludington Hospital
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Covered Entity Details
Entity Name
Corewell Health Ludington Hospital
Subdivision Name
Ludington
Type
Sole Community Hospital
340B ID
SCH230110-00
Entity Address
1 N Atkinson Dr
Ludington, MI 49431
Medicare Provider Number
230110
Participating Start Date
1/1/2020
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
MEIJER PHARMACY #310
Pharmacy Address
4665 S GREEN AVE
FREMONT, MI 49412
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
John Sella, Senior Director, Finance
(616) 643-9168
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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