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MEIJER DISTRIBUTION INC #90
CAH231332-00 BRONSON LAKEVIEW HOSPITAL
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Covered Entity Details
Entity Name
BRONSON LAKEVIEW HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH231332-00
Entity Address
408 HAZEN STREET
PAW PAW, MI 49079
Medicare Provider Number
231332
Participating Start Date
4/1/2011
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
MEIJER DISTRIBUTION INC #90
Pharmacy Address
2721 WALKER AVE NW
GRAND RAPIDS, MI 49544
Pharmacy Comments
Distribution Center
Contract Details
Approval Date
7/2/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/1/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
James B. Falahee Jr., Sr. Vice President, Legal & Legislative Affairs
(269) 341-8907
Contract Pharmacy Representative
Meijer
Jeff Romano, Hospital Programs
(616) 791-3171
Signed By Date
7/2/2014
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