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MEDCART SPECIALTY PHARMACY
RWI48201 Matrix Human Services
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Covered Entity Details
Entity Name
Matrix Human Services
Subdivision Name
Matrix Quality Care - Ryan White Division
Type
Ryan White Part A
340B ID
RWI48201
Entity Address
1400 Woodbridge Street
Detroit, MI 48207
Grant Number
H89HA00021
Participating Start Date
1/1/2015
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
MEDCART SPECIALTY PHARMACY
Pharmacy Address
32131 INDUSTRIAL ROAD
LIVONIA, MI 48150
Pharmacy Comments
Contract Details
Approval Date
4/27/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Karen Bisdorf, Chief Operating Officer
(313) 831-8650
Contract Pharmacy Representative
Fungisai Nota, 340B Program Manager
(610) 675-6594
Signed By Date
4/27/2015
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