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HOMETOWN PHARMACY, INC.
DSH230038 Corewell Health Grand Rapids Hospitals Butterworth Hospital
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Covered Entity Details
Entity Name
Corewell Health Grand Rapids Hospitals Butterworth Hospital
Subdivision Name
BUTTERWORTH HOSPITAL
Type
Disproportionate Share Hospital
340B ID
DSH230038
Entity Address
100 MICHIGAN STREET NE
GRAND RAPIDS, MI 49503-2560
Medicare Provider Number
230038
Participating Start Date
4/1/2004
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
HOMETOWN PHARMACY, INC.
Pharmacy Address
DBA HOMETOWN PHARMACY #23 - KENT CITY
6 S MAIN ST
KENT CITY, MI 49330
Pharmacy Comments
Contract Details
Approval Date
7/19/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/3/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
Shawn Ulreich, VP Clinical Operations/CNE
(616) 391-1065
Contract Pharmacy Representative
Hometown
Luke Johnsen, Analyst
(231) 861-6900
Signed By Date
7/19/2021
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