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WEATHERWAX FAMILY PHARMACIES INC
DSH230092 W. A. Foote Memorial Hospital dba Henry Ford Health Jackson Hospital
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Covered Entity Details
Entity Name
W. A. Foote Memorial Hospital dba Henry Ford Health Jackson Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230092
Entity Address
205 N. East Ave
JACKSON, MI 49201
Medicare Provider Number
230092
Participating Start Date
4/1/2011
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
WEATHERWAX FAMILY PHARMACIES INC
Pharmacy Address
105 N MAIN ST
BROOKLYN, MI 49230-8979
Pharmacy Comments
Contract Details
Approval Date
9/26/2012
Contract Begin Date
9/26/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
JEANNE WICKENS, SVP OF FINANCE/CFO
(517) 841-6979
Contract Pharmacy Representative
Jim Weatherwax, President
(517) 784-3184
Signed By Date
9/10/2012
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