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MAPLE VALLEY PHARMACY
CAH231339-00 Corewell Health Pennock Hospital
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Covered Entity Details
Entity Name
Corewell Health Pennock Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH231339-00
Entity Address
1009 west Green Street
Hastings, MI 49058
Medicare Provider Number
231339
Participating Start Date
7/1/2019
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
MAPLE VALLEY PHARMACY
Pharmacy Address
219 N MAIN ST
NASHVILLE, MI 49073
Pharmacy Comments
Contract Details
Approval Date
10/15/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
John Sella, Senior Director, Finance
(616) 643-9168
Contract Pharmacy Representative
Maple Valley Pharmacy
Eddie Said, Officer
(517) 615-4700
Signed By Date
10/15/2023
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