340B Drug Pricing Program Database

Pharmacy Name

HENRY FORD MEDICAL CENTER PHARMACY-FORD

Pharmacy Address

5500 AUTO CLUB DR
DEARBORN, MI 48126

Pharmacy Comments

Approval Date

4/16/2013

Contract Begin Date

7/1/2013

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

4/16/2013