340B Drug Pricing Program Database
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Walmart Pharmacy 10-7611
DSH230066 Trinity Health Muskegon Hospital
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Covered Entity Details
Entity Name
Trinity Health Muskegon Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230066
Entity Address
1500 E. Sherman Blvd.
Muskegon, MI 49444
Medicare Provider Number
230066
Participating Start Date
1/1/2005
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
1/12/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Daniel G. Green, Vice President for Finance
(616) 685-6709
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/12/2024
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