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HACKLEY PROFESSIONAL PHARMACY, INC
DSH230066 Trinity Health Muskegon Hospital
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Covered Entity Details
Entity Name
Trinity Health Muskegon Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230066
Entity Address
1500 E. Sherman Blvd.
Muskegon, MI 49444
Medicare Provider Number
230066
Participating Start Date
1/1/2005
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
HACKLEY PROFESSIONAL PHARMACY, INC
Pharmacy Address
DBA TRINITY HEALTH PHARMACY - NORTON SH
3570 HENRY ST.
SUITE 100
NORTON SHORES, MI 49441
Pharmacy Comments
Contract Details
Approval Date
6/20/2012
Contract Begin Date
7/1/2012
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Gary Allore, CFO
(231) 728-4809
Contract Pharmacy Representative
Gary Allore, CFO
(231) 728-4809
Signed By Date
6/8/2012
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