Contract Pharmacy Details

DEXTER PHARMACY
DSH230046 UNIVERSITY OF MICHIGAN HOSPITALS AND HEALTH CENTERS

Covered Entity Details

Entity Name

UNIVERSITY OF MICHIGAN HOSPITALS AND HEALTH CENTERS

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH230046

Entity Address

1500 EAST MEDICAL CENTER DRIVE
ANN ARBOR, MI 48109

Medicare Provider Number

230046

Participating Start Date

1/1/2004

Last Recertification Date

8/20/2024

Pharmacy Details

Pharmacy Name

DEXTER PHARMACY

Pharmacy Address

2820 BAKER ROAD
SUITE 100
DEXTER, MI 48130

Pharmacy Comments

Contract Details

Approval Date

3/13/2012

Contract Begin Date

3/13/2012

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

8/23/2019
Pharmacy closed

Contacts

Covered Entity Signing Official

James G. Stevenson, Director of Pharmacy Services
(734) 647-7794

Contract Pharmacy Representative

Jennifer Acra, Owner
(734) 929-8688

Signed By Date

2/28/2012

340B Drug Pricing Program Database