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BEAUMONT INFUSION PHARMACY
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
BEAUMONT INFUSION PHARMACY
Pharmacy Address
DBA-COREWELL HEALTH BEAUMONT TROY HOSPIT
44344 DEQUINDRE RD STE 230
STERLING HEIGHTS, MI 48314
Pharmacy Comments
Contract Details
Approval Date
4/13/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Paul LaCasse, President & Chief Executive Officer
(248) 471-8949
Contract Pharmacy Representative
Scott Dufour, Director Pharmacy
(248) 964-4036
Signed By Date
4/13/2016
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