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HENRY FORD PHARMACY ADVANTAGE
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
HENRY FORD PHARMACY ADVANTAGE
Pharmacy Address
2799 W GRAND BLVD
STE 100B
DETROIT, MI 48202-2608
Pharmacy Comments
Contract Details
Approval Date
7/13/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
PAULA M. REICHLE, SR VP AND CFO
(517) 364-5400
Contract Pharmacy Representative
Henry Ford Pharmacy Advantage Southfield
Doug Samojedny, Director-Pharmacy Advantage Operations
(248) 528-4530
Signed By Date
7/13/2016
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