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TRINITY HEALTH-MICHIGAN
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
TRINITY HEALTH-MICHIGAN
Pharmacy Address
TRINITY HEALTH CMH PHARMACY-MUSKEGON
376 E APPLE AVE STE 1A
MUSKEGON, MI 49442
Pharmacy Comments
Contract Details
Approval Date
4/14/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/26/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kristi Nagengast, Vice President of Finance
(231) 672-3802
Contract Pharmacy Representative
DSH230059
Terry Kirkpatrick, Director of Pharmacy Services
(616) 685-6108
Signed By Date
4/14/2017
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