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WILLIAM BEAUMONT HOSPITAL
CH053752B COVENANT COMMUNITY CARE, INC.
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Covered Entity Details
Entity Name
COVENANT COMMUNITY CARE, INC.
Subdivision Name
Covenant Woodward Avenue
Type
HRSA-Funded Health Center
340B ID
CH053752B
Entity Address
27776 Woodward Ave
Royal Oak, MI 48067-0970
Grant Number
H80CS08738
Participating Start Date
10/1/2010
Last Recertification Date
2/7/2023
Entity Termination Date
4/1/2024
Pharmacy Details
Pharmacy Name
WILLIAM BEAUMONT HOSPITAL
Pharmacy Address
DBA - COREWELL HEALTH WILLIAM BEAUMONT U
PHARMACY
3601 W 13 MILE RD
ROYAL OAK, MI 48073
Pharmacy Comments
Contract Details
Approval Date
3/18/2011
Contract Begin Date
3/21/2011
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/1/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
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