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WOODWARD DETROIT CVS, L.L.C.
DSH230207 McLaren Oakland
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Covered Entity Details
Entity Name
McLaren Oakland
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230207
Entity Address
50 NORTH PERRY
PONTIAC, MI 48342
Medicare Provider Number
230207
Participating Start Date
1/1/2005
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
WOODWARD DETROIT CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 08049
4995 HIGHLAND RD.
WATERFORD, MI 48328
Pharmacy Comments
Contract Details
Approval Date
1/17/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/16/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Matthew LeGault, CFO
(248) 338-5691
Contract Pharmacy Representative
CVS
Christian Reid, 340B Program Director, CVS Pharmacy
(401) 770-2118
Signed By Date
1/17/2017
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