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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 - MUSKEGON
1500 E SHERMAN BLVD
GARDEN LEVEL P-200
MUSKEGON, MI 49444
Pharmacy Comments
Contract Details
Approval Date
10/14/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kristi Nagengast, Vice President of Finance
(231) 672-3802
Contract Pharmacy Representative
George A. Kuhnert, Pharmacy Director
(231) 672-3022
Signed By Date
10/14/2016
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