Contract Pharmacy Details

HOMETOWN PHARMACY #40 - ANN ARBOR
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

HOMETOWN PHARMACY #40 - ANN ARBOR

Pharmacy Address

2355 E STADIUM BLVD
ANN ARBOR, MI 48104

Pharmacy Comments

Contract Details

Approval Date

7/14/2014

Contract Begin Date

10/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/1/2022
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Tony Denton, COO
(734) 647-6623

Contract Pharmacy Representative

Hometown Pharmacy Inc.
Jim Grice, Vice President
(231) 861-6900

Signed By Date

7/14/2014

340B Drug Pricing Program Database