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CROWN SPECIALTY PHARMACY
RWI48201C Matrix Human Services
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Covered Entity Details
Entity Name
Matrix Human Services
Subdivision Name
Corewell Health Infection Disease - Westland
Type
Ryan White Part A
340B ID
RWI48201C
Entity Address
2001 S. Merriman Rd. Suite 300
300
Westland, MI 48186
Grant Number
H89HA00021
Participating Start Date
7/1/2024
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
CROWN SPECIALTY PHARMACY
Pharmacy Address
CROWN PHARMACY
24401 PLYMOUTH RD
REDFORD, MI 48239-1616
Pharmacy Comments
Contract Details
Approval Date
7/15/2024
Contract Begin Date
10/1/2024
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
Crown Pharmacy
Ali Fakih, President & CEO
(303) 532-3784
Signed By Date
7/15/2024
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