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MEIJER INC #195
DSH230017 BRONSON METHODIST HOSPITAL
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Covered Entity Details
Entity Name
BRONSON METHODIST HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230017
Entity Address
601 JOHN STREET
KALAMAZOO, MI 49007
Medicare Provider Number
230017
Participating Start Date
7/1/2004
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
MEIJER INC #195
Pharmacy Address
6405 B DRIVE NORTH
BATTLE CREEK, MI 49014
Pharmacy Comments
Contract Details
Approval Date
4/15/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/1/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Marty Meitz, CFO
(269) 341-8988
Contract Pharmacy Representative
Meijer
Jeff Romano, Hospital Programs
(616) 791-3171
Signed By Date
4/15/2014
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