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HENRY FORD PHARMACY ADVANTAGE SOUTHFIELD
CAH231326-00 SPARROW CLINTON HOSPITAL
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Covered Entity Details
Entity Name
SPARROW CLINTON HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH231326-00
Entity Address
805 S. OAKLAND ST
ST. JOHNS, MI 48879
Medicare Provider Number
231326
Participating Start Date
9/22/2010
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
HENRY FORD PHARMACY ADVANTAGE SOUTHFIELD
Pharmacy Address
1191 SOUTH BLVD. E.
ROCHESTER HILLS, MI 48307
Pharmacy Comments
Contract Details
Approval Date
4/16/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/8/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
EDWARD BRUUN, PRESIDENT/CEO
(989) 224-6881
Contract Pharmacy Representative
Henry Ford Health System
Crystal Whitbeck, Pharmacist
(248) 723-0284
Signed By Date
4/16/2018
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