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MEIJER INC #21
DSH230015 THREE RIVERS HEALTH
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Covered Entity Details
Entity Name
THREE RIVERS HEALTH
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230015
Entity Address
701 S. HEALTH PARKWAY
THREE RIVERS, MI 49093
Medicare Provider Number
230015
Participating Start Date
10/1/2011
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
MEIJER INC #21
Pharmacy Address
5800 GULL ROAD
KALAMAZOO, MI 49048
Pharmacy Comments
Contract Details
Approval Date
4/11/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/8/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
STEVEN T. ANDREWS, CFO
(269) 273-9604
Contract Pharmacy Representative
Meijer
Kevin Hurn, Dir, Pharmacy Procurement and New Business
(616) 791-5185
Signed By Date
4/11/2018
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