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MEIJER STORES LIMITED PARTNERSHIP
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
MEIJER STORES LIMITED PARTNERSHIP
Pharmacy Address
D/B/A MEIJER PHARMACY #463
1515 PROFIT DR.
FORT WAYNE, IN 46808
Pharmacy Comments
Contract Details
Approval Date
1/17/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Priscilla Kay Mahar, Chief Operating and Compliance Officer
(616) 225-6313
Contract Pharmacy Representative
Meijer
Kevin Hurn, Dir, Pharmacy Procurement and New Business
(616) 791-5185
Signed By Date
1/7/2013
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