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MEIJER PHARMACY #464
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 PHARMACY #464
Pharmacy Address
41255 COCA COLA DR.
BELLEVILLE, MI 48111-1827
Pharmacy Comments
Contract Details
Approval Date
10/18/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/23/2018
Agreement registered in error
Contacts
Covered Entity Signing Official
Priscilla Kay Mahar, Chief Operating and Compliance Officer
(616) 225-6313
Contract Pharmacy Representative
Meijer
Jeff Romano, Hospital Programs
(616) 791-3171
Signed By Date
10/18/2016
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