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FAMILY FARE PHARMACY
DSH230072 HOLLAND HOSPITAL
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Covered Entity Details
Entity Name
HOLLAND HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230072
Entity Address
602 MICHIGAN AVENUE
HOLLAND, MI 49423-4999
Medicare Provider Number
230072
Participating Start Date
1/1/2012
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
FAMILY FARE PHARMACY
Pharmacy Address
1185 SOUTH WASHINGTON AVENU
HOLLAND, MI 49423
Pharmacy Comments
Contract Details
Approval Date
4/18/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
TERRY L. STEELE, CFO
(616) 392-5141
Contract Pharmacy Representative
SpartanNash
Eddie Garcia, Director of Pharmacy
(616) 878-2975
Signed By Date
4/18/2016
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