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TRINITY HEALTH PHARMACY - CATHEDRAL SQUA
DSH230059 SAINT MARY'S HEALTH CARE
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Covered Entity Details
Entity Name
SAINT MARY'S HEALTH CARE
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230059
Entity Address
200 JEFFERSON SE
GRAND RAPIDS, MI 49503
Medicare Provider Number
230059
Participating Start Date
12/1/2005
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
TRINITY HEALTH PHARMACY - CATHEDRAL SQUA
Pharmacy Address
D/B/A TRINITY HEALTH PHARMACY - CATHEDRA
360 DIVISION AVE S STE 1A
GRAND RAPIDS, MI 49503
Pharmacy Comments
Contract Details
Approval Date
12/8/2010
Contract Begin Date
12/13/2010
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
DSH230059
Terry Kirkpatrick, Director of Pharmacy Services
(616) 685-6108
Signed By Date
12/8/2010
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