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Lakeland Pharmacy Shoppe
DSH230021 LAKELAND REGIONAL HEALTH SYSTEM LAKELAND MEDICAL CENTER ST JOSEPH DBA COREWELL HEALTH LAKELAND HOSPITALS
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Covered Entity Details
Entity Name
LAKELAND REGIONAL HEALTH SYSTEM LAKELAND MEDICAL CENTER ST JOSEPH DBA COREWELL HEALTH LAKELAND HOSPITALS
Subdivision Name
LAKELAND HOSPITAL - ST JOSEPH
Type
Disproportionate Share Hospital
340B ID
DSH230021
Entity Address
1234 NAPIER AVENUE
ST JOSEPH, MI 49085
Medicare Provider Number
230021
Participating Start Date
10/1/2004
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
Lakeland Pharmacy Shoppe
Pharmacy Address
3900 Hollywood Road
St. Joseph, MI 49085
Pharmacy Comments
Contract Details
Approval Date
7/6/2012
Contract Begin Date
7/6/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/5/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
TIM CALHOUN, CFO
(269) 983-8398
Contract Pharmacy Representative
Dennis Mack, Vice President of Operations
(269) 983-8399
Signed By Date
7/3/2012
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