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CORAM HEALTHCARE CORPORATION OF INDIANA
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
CORAM HEALTHCARE CORPORATION OF INDIANA
Pharmacy Address
DBA CORAM CVS/SPECIALTY INFUSION SERVICE
1290 ARROWHEAD COURT
SUITE A
CROWN POINT, IN 46307
Pharmacy Comments
Contract Details
Approval Date
4/6/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/21/2018
Pharmacy closed
Contacts
Covered Entity Signing Official
Jeffrey S. Desmond, Chief Medical Officer
(734) 936-5814
Contract Pharmacy Representative
Coram
Katherine Tereszczenko, Pharmacy Manager
(248) 324-6300
Signed By Date
4/6/2018
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