340B Drug Pricing Program Database
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Walmart Pharmacy 10-7611
DSH230151 Botsford General Hospital d/b/a Corewell Health Farmington Hills Hospital
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Covered Entity Details
Entity Name
Botsford General Hospital d/b/a Corewell Health Farmington Hills Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230151
Entity Address
28050 GRAND RIVER AVE
FARMINGTON HILLS, MI 48336
Medicare Provider Number
230151
Participating Start Date
4/1/2015
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
10/16/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/15/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Nancy Ann Susick, COO
(947) 522-3349
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/16/2023
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