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PROMEDICA PHARMACY GROUP LLC
DSH230099 MONROE REGIONAL HOSPITAL
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Covered Entity Details
Entity Name
MONROE REGIONAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230099
Entity Address
718 NORTH MACOMB
MONROE, MI 48162
Medicare Provider Number
230099
Participating Start Date
1/1/2022
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
PROMEDICA PHARMACY GROUP LLC
Pharmacy Address
PROMEDICA SPECIALTY PHARMACY
3142 W CENTRAL AVE
TOLEDO, OH 43606
Pharmacy Comments
Contract Details
Approval Date
10/15/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Joseph Raj Jr., Director Finance
(734) 240-4524
Contract Pharmacy Representative
ProMedica Health System
Bryan Coehrs, Director of Pharmacy Operations
(419) 460-0202
Signed By Date
10/15/2024
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