340B Drug Pricing Program Database

Pharmacy Name

HENRY FORD WEST BLOOMFIELD HOSPITAL PHAR

Pharmacy Address

6777 W MAPLE RD
WEST BLOOMFIELD, MI 48322-3013

Pharmacy Comments

Approval Date

9/22/2011

Contract Begin Date

9/22/2011

Carve-In Effective Date

Contract Comments

Covered Entity Signing Official

James Connelly, CFO
(313) 876-8714

Contract Pharmacy Representative

Henry Ford Health System
Daniel Kus, V.P. Pharmacy Services
(248) 723-0252

Signed By Date

9/6/2011