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WOODWARD DETROIT CVS, L.L.C.
DSH230230 EDWARD W SPARROW HOSPITAL ASSOCIATION
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Covered Entity Details
Entity Name
EDWARD W SPARROW HOSPITAL ASSOCIATION
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230230
Entity Address
1215 E MICHIGAN AVE
LANSING, MI 48912
Medicare Provider Number
230230
Participating Start Date
10/1/2004
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
WOODWARD DETROIT CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 08278
5118 S. MLK JR BLVD.
LANSING, MI 48911
Pharmacy Comments
Contract Details
Approval Date
7/13/2015
Contract Begin Date
10/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/17/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
PAULA M. REICHLE, SR VP AND CFO
(517) 364-5400
Contract Pharmacy Representative
CVS Health
Jaclyn Parfitt, 340B Operations Manager
(401) 770-6467
Signed By Date
7/13/2015
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