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ST MARYS HOSPITAL
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
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
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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