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Walgreens #21423
HV00110 TRINITY HEALTH CORPORATION
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Covered Entity Details
Entity Name
TRINITY HEALTH CORPORATION
Subdivision Name
Special Immunology and Infectious Disease Services
Type
Ryan White Part C
340B ID
HV00110
Entity Address
200 Jefferson SE
GRAND RAPIDS, MI 49503
Grant Number
H76HA00110
Participating Start Date
10/1/2006
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
Walgreens #21423
Pharmacy Address
Walgreens Central Fill #21423
6275 Winchester Blvd
Canal WInchester, OH 43110-6537
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
Daniel G. Green, Vice President for Finance
(616) 685-6709
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/15/2024
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