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DIPLOMAT SPECIALTY PHARMACY
DSH230035 Corewell Health Greenville Hospital
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Covered Entity Details
Entity Name
Corewell Health Greenville Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230035
Entity Address
615 S. BOWER STREET
GREENVILLE, MI 48838
Medicare Provider Number
230035
Participating Start Date
1/20/2010
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
DIPLOMAT SPECIALTY PHARMACY
Pharmacy Address
4100 S SAGINAW ST
STE D
FLINT, MI 48507-2683
Pharmacy Comments
04/09/2012 update address and name (added suite)
Contract Details
Approval Date
6/27/2012
Contract Begin Date
6/27/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/29/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Priscilla Kay Mahar, Chief Operating and Compliance Officer
(616) 225-6313
Contract Pharmacy Representative
Phil Hagerman, Chief Executive Officer
(810) 768-9453
Signed By Date
6/27/2012
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