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TRINITY HEALTH-MICHIGAN
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-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
1/15/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Daniel G. Green, Vice President for Finance
(616) 685-6709
Contract Pharmacy Representative
Mercy Health
Alan Goldman, Pharmacy Manager
(616) 685-1143
Signed By Date
1/15/2016
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