Contract Pharmacy Details

MEIJER INC #175
DSH230096 STURGIS HOSPITAL

Covered Entity Details

Entity Name

STURGIS HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH230096

Entity Address

916 MYRTLE AVENUE
STURGIS, MI 49091

Medicare Provider Number

230096

Participating Start Date

7/1/2011

Last Recertification Date

9/10/2018

Entity Termination Date

7/1/2019

Pharmacy Details

Pharmacy Name

MEIJER INC #175

Pharmacy Address

800 S. US 131
THREE RIVERS, MI 49093

Pharmacy Comments

Contract Details

Approval Date

1/4/2017

Contract Begin Date

4/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/1/2019
Covered Entity Terminated

Contacts

Covered Entity Signing Official

ROBERT J. LABARGE, CEO
(269) 659-4400

Contract Pharmacy Representative

Meijer
Jeff Romano, Hospital Programs
(616) 791-3171

Signed By Date

1/4/2017