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CROWN SPECIALTY PHARMACY
RWI48235 Sinai Grace Specialty Care
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Covered Entity Details
Entity Name
Sinai Grace Specialty Care
Subdivision Name
Type
Ryan White Part A
340B ID
RWI48235
Entity Address
6001 W. Outer Drive, Ste. 207
Detroit, MI 48235
Grant Number
H89HA00021
Participating Start Date
7/1/2024
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
CROWN SPECIALTY PHARMACY
Pharmacy Address
CROWN PHARMACY
24401 PLYMOUTH RD
REDFORD, MI 48239-1616
Pharmacy Comments
Contract Details
Approval Date
3/9/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Evelyn Postell-Franklin, Program Coordinator
(313) 966-2800
Contract Pharmacy Representative
Nota Consulting Group, LLC
Fungisai Nota, 340B Program Manager
(610) 742-7763
Signed By Date
3/9/2016
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