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MEIJER INC #209
CAH231326-00 SPARROW CLINTON HOSPITAL
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Covered Entity Details
Entity Name
SPARROW CLINTON HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH231326-00
Entity Address
805 S. OAKLAND ST
ST. JOHNS, MI 48879
Medicare Provider Number
231326
Participating Start Date
9/22/2010
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
MEIJER INC #209
Pharmacy Address
12821 CROSSOVER DR
DEWITT, MI 48820
Pharmacy Comments
Contract Details
Approval Date
4/16/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/7/2021
Covered Entity Terminated
Contacts
Covered Entity Signing Official
EDWARD BRUUN, PRESIDENT/CEO
(989) 224-6881
Contract Pharmacy Representative
Meijer
Jeff Romano, Hospital Programs
(616) 791-3171
Signed By Date
4/16/2015
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