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LYNNFIELD DRUG INC
DSH230046 UNIVERSITY OF MICHIGAN HOSPITALS AND HEALTH CENTERS
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Covered Entity Details
Entity Name
UNIVERSITY OF MICHIGAN HOSPITALS AND HEALTH CENTERS
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230046
Entity Address
1500 EAST MEDICAL CENTER DRIVE
ANN ARBOR, MI 48109
Medicare Provider Number
230046
Participating Start Date
1/1/2004
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
LYNNFIELD DRUG INC
Pharmacy Address
DBA FREEDOM FERTILITY PHARMACY
374 MERRIMAC ST STE 100
NEWBURYPORT, MA 01950
Pharmacy Comments
Contract Details
Approval Date
4/6/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jeffrey S. Desmond, Chief Medical Officer
(734) 936-5814
Contract Pharmacy Representative
Accredo
Sameh Garas, Pharmacist In Charge
(901) 385-3600
Signed By Date
4/6/2018
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