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WILLIAM BEAUMONT HOSPITAL
DSH230072 HOLLAND HOSPITAL
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Covered Entity Details
Entity Name
HOLLAND HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230072
Entity Address
602 MICHIGAN AVENUE
HOLLAND, MI 49423-4999
Medicare Provider Number
230072
Participating Start Date
1/1/2012
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
WILLIAM BEAUMONT HOSPITAL
Pharmacy Address
DBA COREWELL HEALTH SPECIALTY PHARMACY
41965 ECORSE RD
STE 100
VAN BUREN TWP, MI 48111
Pharmacy Comments
Contract Details
Approval Date
1/15/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mark Pawlak, President
(616) 392-5141
Contract Pharmacy Representative
Corewell Health East
Scott Sterrett, Manager of Pharmacy
(586) 753-4175
Signed By Date
1/15/2024
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