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MEIJER STORES LIMITED PARTNERSHIP
DSH230130 Corewell Health William Beaumont University Hospital
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Covered Entity Details
Entity Name
Corewell Health William Beaumont University Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230130
Entity Address
3601 WEST 13 MILE ROAD
ROYAL OAK, MI 48073-6769
Medicare Provider Number
230130
Participating Start Date
4/1/2024
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
MEIJER STORES LIMITED PARTNERSHIP
Pharmacy Address
D/B/A MEIJER PHARMACY #463
1515 PROFIT DR.
FORT WAYNE, IN 46808
Pharmacy Comments
Contract Details
Approval Date
1/31/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Hardik Dalal, SVP, Finance & System-wide Pharmacy Finance
(312) 771-0810
Contract Pharmacy Representative
Meijer
Kevin Hurn, Dir, Pharmacy Procurement and New Business
(616) 791-5185
Signed By Date
1/16/2024
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