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ACCREDO HEALTH GROUP, INC.
DSH230081 MUNSON HEALTHCARE CADILLAC HOSPITAL
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Covered Entity Details
Entity Name
MUNSON HEALTHCARE CADILLAC HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230081
Entity Address
400 HOBART ST
CADILLAC, MI 49601
Medicare Provider Number
230081
Participating Start Date
4/1/2022
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
ACCREDO HEALTH GROUP, INC.
Pharmacy Address
2825 W PERIMETER RD STE 112
INDIANAPOLIS, IN 46241
Pharmacy Comments
Contract Details
Approval Date
2/23/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/30/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
Alicia Maitland, CFO
(231) 935-7840
Contract Pharmacy Representative
Accredo Health Group Inc.
Tony Atkinson, Sales Director
(513) 581-7562
Signed By Date
1/18/2022
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