Contract Pharmacy Details

INFUPHARMA LLC
RRC230146-00 HENRY FORD HEALTH WYANDOTTE HOSPITAL

Covered Entity Details

Entity Name

HENRY FORD HEALTH WYANDOTTE HOSPITAL

Subdivision Name

Type

Rural Referral Center

340B ID

RRC230146-00

Entity Address

2333 BIDDLE
WYANDOTTE, MI 48192

Medicare Provider Number

230146

Participating Start Date

7/1/2018

Last Recertification Date

8/26/2024

Pharmacy Details

Pharmacy Name

INFUPHARMA LLC

Pharmacy Address

DBA GLOBAL VIEW PHARMACY
2013 HARDING ST
HOLLYWOOD, FL 33020

Pharmacy Comments

Contract Details

Approval Date

1/10/2025

Contract Begin Date

4/1/2025

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Doug Clark, SVP - Corporate Finance
(313) 874-5446

Contract Pharmacy Representative

AvevoRx
Justin Dent, Vice President of Operations
(336) 210-6580

Signed By Date

1/10/2025

340B Drug Pricing Program Database