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TRINITY HEALTH PHARMACY - CATHEDRAL SQUA
HV00110 TRINITY HEALTH CORPORATION
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Covered Entity Details
Entity Name
TRINITY HEALTH CORPORATION
Subdivision Name
Special Immunology and Infectious Disease Services
Type
Ryan White Part C
340B ID
HV00110
Entity Address
200 Jefferson SE
GRAND RAPIDS, MI 49503
Grant Number
H76HA00110
Participating Start Date
10/1/2006
Last Recertification Date
2/17/2025
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
7/21/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Steve Eavenson, VP for Finance
(616) 685-4353
Contract Pharmacy Representative
Dave Benedetti, Pharmacy Manager
(616) 685-6658
Signed By Date
7/21/2014
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