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KROGER CO OF MICHIGAN #680
DSH230230 EDWARD W SPARROW HOSPITAL ASSOCIATION
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Covered Entity Details
Entity Name
EDWARD W SPARROW HOSPITAL ASSOCIATION
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230230
Entity Address
1215 E MICHIGAN AVE
LANSING, MI 48912
Medicare Provider Number
230230
Participating Start Date
10/1/2004
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
KROGER CO OF MICHIGAN #680
Pharmacy Address
1100 W. ARGYLE ST.
JACKSON, MI 49202
Pharmacy Comments
Contract Details
Approval Date
1/5/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/13/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
William Howe, SHS-VP Chief Financial Officer Sparrow Hospital
(517) 253-6102
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
1/5/2022
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