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KROGER DBA: KESSEL #411
DSH230070 COVENANT MEDICAL CENTER
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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
KROGER DBA: KESSEL #411
Pharmacy Address
5025 GRATIOT ROAD
SAGINAW, MI 48638
Pharmacy Comments
Contract Details
Approval Date
7/17/2013
Contract Begin Date
10/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/19/2017
Pharmacy closed
Contacts
Covered Entity Signing Official
SPENCE MAIDLOW, CEO
(989) 583-6400
Contract Pharmacy Representative
Kroger
Mike Puccini, New Business Development Manager
(513) 762-4672
Signed By Date
7/17/2013
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