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SUPER-X DRUGS CORPORATION
DSH230046 UNIVERSITY OF MICHIGAN HOSPITALS AND HEALTH CENTERS
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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
SUPER-X DRUGS CORPORATION
Pharmacy Address
DBA THE KROGER CO OF MICH#688
400 S. MAPLE ROAD
ANN ARBOR, MI 48103
Pharmacy Comments
Contract Details
Approval Date
6/27/2012
Contract Begin Date
6/27/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/22/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
James G. Stevenson, Director of Pharmacy Services
(734) 647-7794
Contract Pharmacy Representative
Kroger
Mike Puccini, New Business Development Manager
(513) 762-4672
Signed By Date
6/18/2012
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