Contract Pharmacy Details

MEIJER DISTRIBUTION INC #90
DSH230070 COVENANT MEDICAL CENTER

Covered Entity Details

Entity Name

COVENANT MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH230070

Entity Address

1447 N HARRISON STREET
SAGINAW, MI 48602

Medicare Provider Number

230070

Participating Start Date

4/1/2004

Last Recertification Date

8/13/2024

Pharmacy Details

Pharmacy Name

MEIJER DISTRIBUTION INC #90

Pharmacy Address

2721 WALKER AVE NW
GRAND RAPIDS, MI 49544

Pharmacy Comments

Distribution Center

Contract Details

Approval Date

4/15/2013

Contract Begin Date

7/1/2013

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

SPENCE MAIDLOW, CEO
(989) 583-6400

Contract Pharmacy Representative

Meijer
Kevin Hurn, Dir, Pharmacy Procurement and New Business
(616) 791-5185

Signed By Date

4/15/2013

340B Drug Pricing Program Database