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WOODWARD DETROIT CVS, L.L.C.
CH050220 INTERCARE COMMUNITY HEALTH NETWORK
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Covered Entity Details
Entity Name
INTERCARE COMMUNITY HEALTH NETWORK
Subdivision Name
INTERCARE ADMINISTRATION
Type
HRSA-Funded Health Center
340B ID
CH050220
Entity Address
50 Industrial Park Rd
Bangor, MI 49013-1246
Grant Number
H80CS00771
Participating Start Date
7/1/1998
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
WOODWARD DETROIT CVS, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY # 10137
132 DOUGLAS AVE.
HOLLAND, MI 49424
Pharmacy Comments
Contract Details
Approval Date
4/5/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
VELMA HENDERSHOTT, CEO
(269) 427-7937 Ext: 200
Contract Pharmacy Representative
Wellpartner, a CVS Company
Derek Stearns, National Sales Exec
(503) 317-9840
Signed By Date
4/5/2018
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