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WOODWARD DETROIT CVS, LLC
DSH230053 HENRY FORD HOSPITAL
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Covered Entity Details
Entity Name
HENRY FORD HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230053
Entity Address
2799 WEST GRAND BLVD
DETROIT, MI 48202
Medicare Provider Number
230053
Participating Start Date
10/1/2002
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
WOODWARD DETROIT CVS, LLC
Pharmacy Address
DBA: CVS/PHARMACY # 08213
13545 EUREKA ROAD
SOUTHGATE, MI 48195
Pharmacy Comments
Contract Details
Approval Date
4/2/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/1/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
Joe Schmitt, Sr. VP & Acting CFO
(313) 876-8714
Contract Pharmacy Representative
CVS Caremark
Anthony Gratto, 340B Vendor Manager
(401) 770-7298
Signed By Date
4/2/2014
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