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TRINITY HEALTH-MICHIGAN
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-MICHIGAN
Pharmacy Address
TRINITY HEALTH LONG TERM CARE PHARMACY-C
360 DIVISION AVE S STE 1C
GRAND RAPIDS, MI 49503
Pharmacy Comments
07/12/2013 - Undeleted per OPA Instructions and updated the pharmacy details. 06/17/2013 - Deleted duplicate for PharmacyID-15939 per OPA instructions.
Contract Details
Approval Date
5/31/2011
Contract Begin Date
7/1/2011
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
5/26/2011
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