Covered Entity Details

RRC230167-10 MCLAREN GREATER LANSING (Terminated) - information as of 4/30/2025 10:50:12 PM

Main Details

Name

MCLAREN GREATER LANSING

Subdivision Name

MCLAREN GREATER LANSING - Meridian Women's Health

Type

Rural Referral Center

Rural

Yes

340B ID

RRC230167-10

Medicare Provider Number

230167

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

10/11/2024

Participating Start Date

1/1/2025

Participating Approval Date

11/4/2024

Last Recertification Date

Termination Date
Termination Reason

4/1/2025
Change of covered entity type

Contacts

Authorizing Official

McLaren Greater Lansing
Dale Thompson, Chief Financial Officer
(517) 975-7555

Primary Contact

McLaren Health Care
Tiffany Harwood, Corporate Director of 340B Data Analytics
(734) 512-8778

Addresses

Street Address

2104 JOLLY RD
STE 220
OKEMOS, MI 48864-6038

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
MI	5171065	1134104672

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
RRC230167-01	Child	RRC	MCLAREN GREATER LANSING	MCLAREN GREATER LANSING - MMP Imaging	1540 LAKE LANSING RD	LANSING	MI	Terminated
RRC230167-02	Child	RRC	MCLAREN GREATER LANSING	MCLAREN GREATER LANSING - MMP Internal Med	1540 LAKE LANSING RD STE 201	LANSING	MI	Terminated
RRC230167-03	Child	RRC	MCLAREN GREATER LANSING	MCLAREN GREATER LANSING - Mammography/Medical Imaging	3520 FOREST RD	LANSING	MI	Terminated
RRC230167-04	Child	RRC	MCLAREN GREATER LANSING	MCLAREN GREATER LANSING - Neurology/EEG	3101 DISCOVERY DR	LANSING	MI	Terminated
RRC230167-05	Child	RRC	MCLAREN GREATER LANSING	McLaren Greater Lansing - Endoscopy	3520 Forest Rd	Lansing	MI	Terminated
RRC230167-06	Child	RRC	MCLAREN GREATER LANSING	MCLAREN GREATER LANSING - MMP Health Associates	1540 LAKE LANSING RD	LANSING	MI	Terminated
RRC230167-07	Child	RRC	MCLAREN GREATER LANSING	MCLAREN GREATER LANSING - Pain Clinic	3101 DISCOVERY DR	LANSING	MI	Terminated
RRC230167-08	Child	RRC	MCLAREN GREATER LANSING	MCLAREN GREATER LANSING - Cardiovascular	2134 HAMPTON PL	OKEMOS	MI	Terminated
RRC230167-09	Child	RRC	MCLAREN GREATER LANSING	MCLAREN GREATER LANSING - MMP Minimal Invasive Surgical Associates	1540 LAKE LANSING RD STE 104	LANSING	MI	Terminated
RRC230167-10	Child	RRC	MCLAREN GREATER LANSING	MCLAREN GREATER LANSING - Meridian Women's Health	2104 JOLLY RD	OKEMOS	MI	Terminated
RRC230167-11	Child	RRC	MCLAREN GREATER LANSING	MCLAREN GREATER LANSING - Lansing Primary Care	2270 JOLLY RD 1	OKEMOS	MI	Terminated
RRC230167-12	Child	RRC	MCLAREN GREATER LANSING	MCLAREN GREATER LANSING - Grand Ledge Cardio	1035 CHARLEVOIX DR	GRAND LEDGE	MI	Terminated
RRC230167-13	Child	RRC	MCLAREN GREATER LANSING	MCLAREN GREATER LANSING - Family Medicine Residency Clinic	3101 DISCOVERY DR	LANSING	MI	Terminated
RRC230167-14	Child	RRC	MCLAREN GREATER LANSING	MCLAREN GREATER LANSING - Internal Medicine	6465 MILLENNIUM DR STE 100	LANSING	MI	Terminated
RRC230167-15	Child	RRC	MCLAREN GREATER LANSING	MCLAREN GREATER LANSING - Wound Care Clinic	3101 DISCOVERY DR	LANSING	MI	Terminated
RRC230167-16	Child	RRC	MCLAREN GREATER LANSING	MCLAREN GREATER LANSING - Grand Ledge Family Medicine	935 CHARLEVOIX DR	GRAND LEDGE	MI	Terminated
RRC230167-17	Child	RRC	MCLAREN GREATER LANSING	MCLAREN GREATER LANSING - MMP Family Med and Lipid	1540 LAKE LANSING RD	LANSING	MI	Terminated
RRC230167-18	Child	RRC	MCLAREN GREATER LANSING	MCLAREN GREATER LANSING - MMP Cardiology	1540 LAKE LANSING RD	LANSING	MI	Terminated
RRC230167-19	Child	RRC	MCLAREN GREATER LANSING	MCLAREN GREATER LANSING - MGL Cardiovascular Associates Eaton Rapids	1500 S MAIN ST	EATON RAPIDS	MI	Terminated
RRC230167-20	Child	RRC	MCLAREN GREATER LANSING	MCLAREN GREATER LANSING - Cardiothoracic and Vascular Surgery	3520 FOREST RD	LANSING	MI	Terminated
RRC230167-21	Child	RRC	MCLAREN GREATER LANSING	MCLAREN GREATER LANSING - Infusion Center	3520 FOREST RD	LANSING	MI	Terminated
RRC230167-22	Child	RRC	MCLAREN GREATER LANSING	MCLAREN GREATER LANSING - MGL North Lansing Women's Health	1540 LAKE LANSING RD	LANSING	MI	Terminated
RRC230167-23	Child	RRC	MCLAREN GREATER LANSING	MCLAREN GREATER LANSING - Okemos CMC	2104 JOLLY RD STE 240	OKEMOS	MI	Terminated
RRC230167-24	Child	RRC	MCLAREN GREATER LANSING	MCLAREN GREATER LANSING - MMP Family Med Portland	406 KENT ST	PORTLAND	MI	Terminated
RRC230167-25	Child	RRC	MCLAREN GREATER LANSING	MCLAREN GREATER LANSING - MMP Family Med East Lansing	12805 Escanaba Drive	Dewitt	MI	Terminated
RRC230167-26	Child	RRC	MCLAREN GREATER LANSING	MCLAREN GREATER LANSING - Minimally Invasive Surgery Grand Ledge	1035 CHARLEVOIX DR	GRAND LEDGE	MI	Terminated
RRC230167-27	Child	RRC	MCLAREN GREATER LANSING	MCLAREN GREATER LANSING - Women's Health and Internal Medicine Residency	3220 DISCOVERY DR	LANSING	MI	Terminated
RRC230167-28	Child	RRC	MCLAREN GREATER LANSING	MCLAREN GREATER LANSING - Grand Ledge Women's Health	1035 CHARLEVOIX DR	GRAND LEDGE	MI	Terminated
RRC230167-29	Child	RRC	MCLAREN GREATER LANSING	MCLAREN GREATER LANSING - Diagnostic Radiology	1035 CHARLEVOIX DR	GRAND LEDGE	MI	Terminated
RRC230167-30	Child	RRC	MCLAREN GREATER LANSING	MCLAREN GREATER LANSING - Dewitt Healthcare	12805 ESCANABA DR 2	DEWITT	MI	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	4/1/2025 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Hospital Type Change Request		4/1/2025 12:00:00 AM	2/3/2025 11:27 AM
Details	State	Update	Hospital Type Change Request	Active	To Be Terminated	2/3/2025 11:27 AM
Terminations	Termination Date	Update	Hospital Type Change Request		4/1/2025 12:00:00 AM	2/3/2025 11:27 AM
Terminations	Termination Effective Date	Update	Hospital Type Change Request		4/1/2025 12:00:00 AM	2/3/2025 11:27 AM
Terminations	Termination Reason	Update	Hospital Type Change Request		Change of covered entity type	2/3/2025 11:27 AM
Details	State	Update		Approved	Active	1/1/2025 12:01 AM
Contacts	Signed By	Insert	New Registration		Thompson, Dale Chief Financial Officer McLaren Greater Lansing 5179757555	11/4/2024 1:33 PM
Details	340B ID	Update	New Registration		RRC230167-10	11/4/2024 1:33 PM
Details	Entity Subname	Update	New Registration	MCLAREN GREATER LANSING	MCLAREN GREATER LANSING - Meridian Women's Health	11/4/2024 1:33 PM
Dates	Participating Approval Date	Update	New Registration		11/4/2024 1:33:16 PM	11/4/2024 1:33 PM
Details	State	Update	New Registration	Pending	Approved	11/4/2024 1:33 PM
Dates	Signed By Date	Update	New Registration		10/14/2024 9:17:43 AM	11/4/2024 1:33 PM
Dates	Start Date	Update	New Registration		1/1/2025 12:00:00 AM	11/4/2024 1:33 PM
Medicaid Billing	Medicaid: Number	Delete	New Registration	1134104672 (MI)		10/14/2024 9:17 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/14/2024 9:17 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		5171065	10/14/2024 9:17 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		MI	10/14/2024 9:17 AM
Addresses	Main Address	Insert	New Registration		2104 JOLLY RD STE 220 OKEMOS, MI 48864-6038	10/11/2024 12:33 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/11/2024 12:33 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1134104672	10/11/2024 12:33 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		MI	10/11/2024 12:33 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1134104672	10/11/2024 12:33 PM
Medicaid Billing	NPI: State	Insert	New Registration		MI	10/11/2024 12:33 PM
Contacts	Primary Contact	Insert	New Registration		Harwood, Tiffany Corporate Director of 340B Data Analytics McLaren Health Care 7345128778	10/11/2024 12:33 PM
Contacts	Authorizing Official	Insert	New Registration		Thompson, Dale Chief Financial Officer McLaren Greater Lansing 5179757555	10/11/2024 12:33 PM
Details	Assistance Received From Date	Insert	New Registration			10/11/2024 12:33 PM
Details	Assistance Received To Date	Insert	New Registration			10/11/2024 12:33 PM
Details	Last Recertification Date	Insert	New Registration			10/11/2024 12:33 PM
Details	Grant Number	Insert	New Registration			10/11/2024 12:33 PM
Details	340B ID	Insert	New Registration			10/11/2024 12:33 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/11/2024 12:33 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/11/2024 12:33 PM
Details	Medicare Provider Number	Insert	New Registration		230167	10/11/2024 12:33 PM
Details	Entity Name	Insert	New Registration		MCLAREN GREATER LANSING	10/11/2024 12:33 PM
Details	NOFO Number	Insert	New Registration			10/11/2024 12:33 PM
Details	Program Code	Insert	New Registration		RRC	10/11/2024 12:33 PM
Details	Entity Subname	Insert	New Registration		MCLAREN GREATER LANSING	10/11/2024 12:33 PM
Dates	Participating Approval Date	Insert	New Registration			10/11/2024 12:33 PM
Details	State	Insert	New Registration		Pending	10/11/2024 12:33 PM
Dates	Registration Date	Insert	New Registration		10/11/2024 12:33:55 PM	10/11/2024 12:33 PM
Dates	Signed By Date	Insert	New Registration			10/11/2024 12:33 PM
Dates	Start Date	Insert	New Registration			10/11/2024 12:33 PM
Terminations	Termination Comments	Insert	New Registration			10/11/2024 12:33 PM
Terminations	Termination Date	Insert	New Registration			10/11/2024 12:33 PM
Terminations	Termination Effective Date	Insert	New Registration			10/11/2024 12:33 PM
Terminations	Termination Reason	Insert	New Registration			10/11/2024 12:33 PM