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ST MARYS HOSPITAL
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
ST MARYS HOSPITAL
Pharmacy Address
200 JEFFERSON AVE SE
GRAND RAPIDS, MI 49503-4502
Pharmacy Comments
Contract Details
Approval Date
1/25/2017
Contract Begin Date
4/1/2017
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
DSH230059
Terry Kirkpatrick, Director of Pharmacy Services
(616) 685-6108
Signed By Date
1/25/2017
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