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FAMILY FARE PHARMACY #1587
DSH230236 METROPOLITAN HOSPITAL
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Covered Entity Details
Entity Name
METROPOLITAN HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230236
Entity Address
5900 BYRON CENTER AVE SW
WYOMING, MI 49519
Medicare Provider Number
230236
Participating Start Date
7/1/2004
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
FAMILY FARE PHARMACY #1587
Pharmacy Address
1415 E. FULTON STREET
GRAND RAPIDS, MI 49503
Pharmacy Comments
Contract Details
Approval Date
10/9/2013
Contract Begin Date
1/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/21/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
MICHAEL D. FAAS, CEO
(616) 252-4788
Contract Pharmacy Representative
Eddie Garcia, Director of Pharmacy
(616) 878-2975
Signed By Date
10/9/2013
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