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MEIJER INC #20
DSH230038 Corewell Health Grand Rapids Hospitals Butterworth Hospital
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Covered Entity Details
Entity Name
Corewell Health Grand Rapids Hospitals Butterworth Hospital
Subdivision Name
BUTTERWORTH HOSPITAL
Type
Disproportionate Share Hospital
340B ID
DSH230038
Entity Address
100 MICHIGAN STREET NE
GRAND RAPIDS, MI 49503-2560
Medicare Provider Number
230038
Participating Start Date
4/1/2004
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
MEIJER INC #20
Pharmacy Address
2425 ALPINE AVE., N.W.
GRAND RAPIDS, MI 49544
Pharmacy Comments
Contract Details
Approval Date
11/14/2011
Contract Begin Date
11/15/2011
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mark Guzicki, Vice President, Home and Community Based Services
(616) 648-9143
Contract Pharmacy Representative
Meijer
Kevin Hurn, Dir, Pharmacy Procurement and New Business
(616) 791-5185
Signed By Date
11/10/2011
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