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WAYLAND VILLAGE DRUG INC
DSH230236 METROPOLITAN HOSPITAL
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Covered Entity Details
Entity Name
METROPOLITAN HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230236
Entity Address
5900 BYRON CENTER AVE SW
WYOMING, MI 49519
Medicare Provider Number
230236
Participating Start Date
7/1/2004
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
WAYLAND VILLAGE DRUG INC
Pharmacy Address
300 RENO DR
WAYLAND, MI 49348-1277
Pharmacy Comments
Contract Details
Approval Date
7/19/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kris Kurtz, CFO
(616) 252-4844
Contract Pharmacy Representative
Wayland Village Drug
Andy C Mai, Pharmacist
(616) 792-6223
Signed By Date
7/19/2021
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