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BOTSFORD GENERAL HOSPITAL
DSH230151 Botsford General Hospital d/b/a Corewell Health Farmington Hills Hospital
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Covered Entity Details
Entity Name
Botsford General Hospital d/b/a Corewell Health Farmington Hills Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230151
Entity Address
28050 GRAND RIVER AVE
FARMINGTON HILLS, MI 48336
Medicare Provider Number
230151
Participating Start Date
4/1/2015
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
BOTSFORD GENERAL HOSPITAL
Pharmacy Address
DBA - COREWELL HEALTH RETAIL PHARMACY -
28050 GRAND RIVER AVE STE 101
FARMINGTON HILLS, MI 48336
Pharmacy Comments
Contract Details
Approval Date
4/15/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/22/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Paul LaCasse, President & Chief Executive Officer
(248) 471-8949
Contract Pharmacy Representative
Kathryn Ratts, Manager, Botsford Outpatient Pharmacy
(248) 888-2513
Signed By Date
4/15/2015
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