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WAL-MART PHARMACY 10-1923
CH051840 TRINITY HEALTH CORPORATION
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Covered Entity Details
Entity Name
TRINITY HEALTH CORPORATION
Subdivision Name
Type
HRSA-Funded Health Center
340B ID
CH051840
Entity Address
200 JEFFERSON STREET SOUTHEAST
GRAND RAPIDS, MI 49503
Grant Number
H80CS00031
Participating Start Date
10/1/2006
Last Recertification Date
2/18/2020
Entity Termination Date
10/1/2020
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1923
Pharmacy Address
3999 ALPINE AVE
COMSTOCK PARK, MI 49321
Pharmacy Comments
Contract Details
Approval Date
1/19/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Daniel G. Green, Vice President for Finance
(616) 685-6709
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
1/19/2016
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