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LAFAYETTE DRUGS, INC
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
LAFAYETTE DRUGS, INC
Pharmacy Address
670 CHENE ST
DETROIT, MI 48207-3979
Pharmacy Comments
Contract Details
Approval Date
1/14/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/3/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Joe Schmitt, Sr. VP & Acting CFO
(313) 876-8714
Contract Pharmacy Representative
William Semaan, Owner
(313) 259-0090
Signed By Date
1/14/2015
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