Contract Pharmacy Details

WILLIAM BEAUMONT HOSPITAL
RWI48201B Matrix Human Services

Covered Entity Details

Entity Name

Matrix Human Services

Subdivision Name

William Beaumont Hospital site

Type

Ryan White Part A

340B ID

RWI48201B

Entity Address

3601 W. Thirteen Mile Road
Royal Oak, MI 48073-6769

Grant Number

H89HA00021

Participating Start Date

1/1/2016

Last Recertification Date

2/5/2019

Entity Termination Date

1/1/2020

Pharmacy Details

Pharmacy Name

WILLIAM BEAUMONT HOSPITAL

Pharmacy Address

DBA - COREWELL HEALTH WILLIAM BEAUMONT U
PHARMACY
3601 W 13 MILE RD
ROYAL OAK, MI 48073

Pharmacy Comments

Contract Details

Approval Date

10/22/2015

Contract Begin Date

1/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/12/2019
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Karen Bisdorf, Chief Operating Officer
(313) 831-8650

Contract Pharmacy Representative

Nota Consulting Group, LLC
Fungisai Nota, 340B Program Manager
(610) 742-7763

Signed By Date

10/22/2015

340B Drug Pricing Program Database