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BRONSON SOUTH HAVEN HOSPITAL
CAH231332-00 BRONSON LAKEVIEW HOSPITAL
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Covered Entity Details
Entity Name
BRONSON LAKEVIEW HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH231332-00
Entity Address
408 HAZEN STREET
PAW PAW, MI 49079
Medicare Provider Number
231332
Participating Start Date
4/1/2011
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
BRONSON SOUTH HAVEN HOSPITAL
Pharmacy Address
DBA - BRONSON OUTPATIENT PHARMACY-SOUTH
955 S BAILEY AVE RM NO.180
SOUTH HAVEN, MI 49090-6743
Pharmacy Comments
Contract Details
Approval Date
10/12/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
James B. Falahee Jr., Sr. Vice President, Legal & Legislative Affairs
(269) 341-8907
Contract Pharmacy Representative
Bronson Healthcare Group
HOLLY WAGNER, PHARMACY MANAGER
(269) 341-6244
Signed By Date
10/12/2023
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