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WALGREEN CO.
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
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 15007
425 FULLER AVE NE
GRAND RAPIDS, MI 49503
Pharmacy Comments
Contract Details
Approval Date
5/15/2012
Contract Begin Date
5/15/2012
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
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
5/3/2012
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