Covered Entity Details

DSH230080BG MCLAREN CENTRAL MICHIGAN (Approved) - information as of 6/8/2025 1:06:14 AM

Main Details

Name

MCLAREN CENTRAL MICHIGAN

Subdivision Name

Gladwin Heart and Vascular - Heart and Vascular - Cardiology

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH230080BG

Medicare Provider Number

230080

Outpatient Facility Provider Number

Additional Details

Current Program Status

Approved

Registration Date

4/2/2025

Participating Start Date

7/1/2025

Participating Approval Date

4/3/2025

Last Recertification Date

Contacts

Authorizing Official

DSH230080-00
Tara Soules, Chief Financial Officer
(989) 772-6818

Primary Contact

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

Addresses

Street Address

2137 W M61
Gladwin, MI 48624

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		1841812989

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
DSH230080A	Child	DSH	MCLAREN CENTRAL MICHIGAN	Ready Care and Occupational Medicine	1523 S Mission St	Mt Pleasant	MI	Active
DSH230080AA	Child	DSH	MCLAREN CENTRAL MICHIGAN	RHC - General Surgery Cheboygan	740 South Main St	Cheboygan	MI	Active
DSH230080AB	Child	DSH	MCLAREN CENTRAL MICHIGAN	RHC - Northern Heart and Vascular Petoskey	560 West Mitchell St	Petoskey	MI	Active
DSH230080AC	Child	DSH	MCLAREN CENTRAL MICHIGAN	RHC - Northern Heart and Vascular Cheboygan	740 South Main St	Cheboygan	MI	Active
DSH230080AD	Child	DSH	MCLAREN CENTRAL MICHIGAN	RHC - McLaren Central Michigan Neurosciences	560 West Mitchell St	Petoskey	MI	Active
DSH230080AE	Child	DSH	MCLAREN CENTRAL MICHIGAN	RHC - Evergreen Clinic - Medicine	611 Court St	West Branch	MI	Terminated
DSH230080AF	Child	DSH	MCLAREN CENTRAL MICHIGAN	RHC - Heart and Vascular West Branch	2110 South M 76	West Branch	MI	Active
DSH230080AG	Child	DSH	MCLAREN CENTRAL MICHIGAN	RHC - Family Medicine Gaylord	1320 E M 32	Gaylord	MI	Active
DSH230080AH	Child	DSH	MCLAREN CENTRAL MICHIGAN	RHC - McLaren Central Michigan Urology Services	560 West Mitchell St	Petoskey	MI	Active
DSH230080AJ	Child	DSH	MCLAREN CENTRAL MICHIGAN	RHC - Burns Building Nephrology - Nephrology	560 West Mitchell St	Petoskey	MI	Terminated
DSH230080AK	Child	DSH	MCLAREN CENTRAL MICHIGAN	RHC - McLaren Central Michigan Infectious Disease	560 West Mitchell St	Petoskey	MI	Active
DSH230080AL	Child	DSH	MCLAREN CENTRAL MICHIGAN	RHC - Family and Internal Medicine Cheboygan	740 South Main St	Cheboygan	MI	Active
DSH230080AM	Child	DSH	MCLAREN CENTRAL MICHIGAN	RHC - Digestive Health Associates	560 West Mitchell St	Petoskey	MI	Active
DSH230080AN	Child	DSH	MCLAREN CENTRAL MICHIGAN	RHC - Northern Heart and Vascular Roger City	573 North Bradley Highway	Rogers City	MI	Active
DSH230080AP	Child	DSH	MCLAREN CENTRAL MICHIGAN	RHC - Physical Medicine and Rehab West Branch	2110 South M 76	West Branch	MI	Active
DSH230080AQ	Child	DSH	MCLAREN CENTRAL MICHIGAN	RHC - McLaren Central Michigan Medical Oncology Petoskey	560 West Mitchell St	Petoskey	MI	Active
DSH230080AR	Child	DSH	MCLAREN CENTRAL MICHIGAN	RHC - McLaren Central Michigan Internal Medicine Petoskey	560 West Mitchell St	Petoskey	MI	Active
DSH230080AS	Child	DSH	MCLAREN CENTRAL MICHIGAN	RHC - McLaren Central Michigan Family Medicine Petoskey	820 Arlington Ave	Petoskey	MI	Active
DSH230080AT	Child	DSH	MCLAREN CENTRAL MICHIGAN	Boyne Medical Center Urgent Care	1249 S M 75	Boyne City	MI	Active
DSH230080AU	Child	DSH	MCLAREN CENTRAL MICHIGAN	McLaren Central Michigan Internal Medicine Tawas	312 W M-55	Tawas	MI	ToBeTerminated
DSH230080AV	Child	DSH	MCLAREN CENTRAL MICHIGAN	McLaren Central Michigan Women's Health Thumb	1005 South Van Dyke Rd	Bad Axe	MI	Active
DSH230080AW	Child	DSH	MCLAREN CENTRAL MICHIGAN	McLaren Central Michigan Bay Heart and Vascular	4489 M 61	Standish	MI	Active
DSH230080AX	Child	DSH	MCLAREN CENTRAL MICHIGAN	McLaren Central Michigan Family Medicine Standish	4489 M 61	STANDISH	MI	Active
DSH230080AY	Child	DSH	MCLAREN CENTRAL MICHIGAN	McLaren Central Michigan Family Medicine Mitchell Park	560 W. Mitchell St	Petoskey	MI	Active
DSH230080AZ	Child	DSH	MCLAREN CENTRAL MICHIGAN	MCLAREN CENTRAL MICHIGAN - Karmanos Cancer Institute - West Branch	2110 S M 76	WEST BRANCH	MI	Terminated
DSH230080B	Child	DSH	MCLAREN CENTRAL MICHIGAN	McLaren Central Michigan Medical Arts Internal Medicine	1201 South Drive	Mt Pleasant	MI	Active
DSH230080BA	Child	DSH	MCLAREN CENTRAL MICHIGAN	RHC - McLaren Central Michigan Pediatrics	1201 South Drive	Mount Pleasant	MI	Active
DSH230080BB	Child	DSH	MCLAREN CENTRAL MICHIGAN	RHC - McLaren Central Michigan Northern Heart and Vascular Petoskey	560 West Mitchell St.	Petoskey	MI	Active
DSH230080BC	Child	DSH	MCLAREN CENTRAL MICHIGAN	RHC - McLaren Central Michigan Family Medicine Rogers City	573 North Bradley Highway	Rogers City	MI	Active
DSH230080BD	Child	DSH	MCLAREN CENTRAL MICHIGAN	RHC - McLaren Central Michigan Gladwin Family Medicine	2137 W M61	Gladwin	MI	Active
DSH230080BE	Child	DSH	MCLAREN CENTRAL MICHIGAN	RHC - McLaren Central Michigan Medical Arts Interventional Radiology	1201 South Drive	Mt Pleasant	MI	Active
DSH230080BF	Child	DSH	MCLAREN CENTRAL MICHIGAN	McLaren Central Neurosurgery Gaylord - Neurosurgery	1320 E M 32	Gaylord	MI	Approved
DSH230080BG	Child	DSH	MCLAREN CENTRAL MICHIGAN	Gladwin Heart and Vascular - Heart and Vascular - Cardiology	2137 W M61	Gladwin	MI	Approved
DSH230080BH	Child	DSH	MCLAREN CENTRAL MICHIGAN	Burns Building Neurology/Neurosurgery - Neurology/Neurosurgery	560 West Mitchell St	Petoskey	MI	Approved
DSH230080C	Child	DSH	MCLAREN CENTRAL MICHIGAN	RHC - McLaren Central Michigan Primary Care West Branch	2110 S M76	West Branch	MI	Active
DSH230080D	Child	DSH	MCLAREN CENTRAL MICHIGAN	RHC - McLaren Central Michigan Primary Care Mio	558 Lockwood Lane	Mio	MI	ToBeTerminated
DSH230080E	Child	DSH	MCLAREN CENTRAL MICHIGAN	RHC - McLaren Central Michigan Primary Care Rose City	2990 Campbell Rd	Rose City	MI	ToBeTerminated
DSH230080F	Child	DSH	MCLAREN CENTRAL MICHIGAN	RHC - McLaren Central Michigan Primary Care St. Helen	1360 N Saint Helen Rd	St Helen	MI	ToBeTerminated
DSH230080G	Child	DSH	MCLAREN CENTRAL MICHIGAN	RHC - Primary Care Rifle River - Primary Care	5170 Rifle River Trl	Alger	MI	Terminated
DSH230080H	Child	DSH	MCLAREN CENTRAL MICHIGAN	McLaren Central Michigan Pulmonology	1201 South Drive	Mt Pleasant	MI	Active
DSH230080J	Child	DSH	MCLAREN CENTRAL MICHIGAN	Heart Center - Alma - Cardiology	315 E Warwick Dr	Alma	MI	Terminated
DSH230080K	Child	DSH	MCLAREN CENTRAL MICHIGAN	McLaren Central Michigan Pickard Street Cardiology	5115 E Pickard St	Mt Pleasant	MI	Active
DSH230080L	Child	DSH	MCLAREN CENTRAL MICHIGAN	McLaren Central Michigan Medical Arts General Surgery	1201 South Drive	Mt Pleasant	MI	Active
DSH230080M	Child	DSH	MCLAREN CENTRAL MICHIGAN	McLaren Central Michigan Weidman Clinic Family Medicine	3520 N Woodruff Rd	Weidman	MI	Active
DSH230080N	Child	DSH	MCLAREN CENTRAL MICHIGAN	McLaren Central Michigan Health Park 7 - Internal Medicine	2940 Health Parkway	Mt Pleasant	MI	Active
DSH230080P	Child	DSH	MCLAREN CENTRAL MICHIGAN	Medical Arts Building - Endocrinology - Endocrinology	1201 South Drive	Mt Pleasant	MI	Terminated
DSH230080Q	Child	DSH	MCLAREN CENTRAL MICHIGAN	McLaren Central Michigan Pickard Street Family Practice	5115 E Pickard St	Mt Pleasant	MI	Active
DSH230080R	Child	DSH	MCLAREN CENTRAL MICHIGAN	McLaren Central Michigan Clare Clinic	1509 N McEwan St	Clare	MI	Active
DSH230080S	Child	DSH	MCLAREN CENTRAL MICHIGAN	McLaren Central Michigan Health Park 7 - Urology	2940 Health Parkway	Mt Pleasant	MI	Active
DSH230080T	Child	DSH	MCLAREN CENTRAL MICHIGAN	Health Park 7- Family Practice - Family Practice	2940 Health Parkway	Mt Pleasant	MI	Terminated
DSH230080U	Child	DSH	MCLAREN CENTRAL MICHIGAN	Heath Park 2 - Primary Care - Primary Care	2935 Health Parkway	Mt Pleasant	MI	Terminated
DSH230080V	Child	DSH	MCLAREN CENTRAL MICHIGAN	Health Park 4 - Family Practice - Family Practice	2853 Health Parkway	Mt Pleasant	MI	Terminated
DSH230080W	Child	DSH	MCLAREN CENTRAL MICHIGAN	McLaren Central Michigan Health Park 4 Internal Medicine	2853 Health Parkway	Mt Pleasant	MI	Active
DSH230080X	Child	DSH	MCLAREN CENTRAL MICHIGAN	RHC - McLaren Central Michigan Orthopedics Petoskey	560 West Mitchell St	Petoskey	MI	Active
DSH230080Y	Child	DSH	MCLAREN CENTRAL MICHIGAN	RHC - McLaren Central Michigan Brown City Health Center Family Medicine	7115 Cade Rd	Brown City	MI	Active
DSH230080Z	Child	DSH	MCLAREN CENTRAL MICHIGAN	RHC - McLaren Central Michigan Petoskey Medical Center South Urgent Care	1890 US Hwy 131	Petoskey	MI	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Medicaid Billing	NPI: Number	Insert	Change Request		1841812989	4/4/2025 9:17 AM
Medicaid Billing	NPI: State	Insert	Change Request		MI	4/4/2025 9:17 AM
Contacts	Signed By	Insert	New Registration		Soules, Tara Chief Financial Officer DSH230080-00 9897726818	4/3/2025 10:24 AM
Details	340B ID	Update	New Registration		DSH230080BG	4/3/2025 10:24 AM
Details	Entity Subname	Update	New Registration	Gladwin Heart and Vascular	Gladwin Heart and Vascular - Heart and Vascular - Cardiology	4/3/2025 10:24 AM
Dates	Participating Approval Date	Update	New Registration		4/3/2025 10:24:43 AM	4/3/2025 10:24 AM
Details	State	Update	New Registration	Pending	Approved	4/3/2025 10:24 AM
Dates	Signed By Date	Update	New Registration		4/2/2025 3:54:19 PM	4/3/2025 10:24 AM
Dates	Start Date	Update	New Registration		7/1/2025 12:00:00 AM	4/3/2025 10:24 AM
Addresses	Main Address	Insert	New Registration		2137 W M61 Gladwin, MI 48624	4/2/2025 1:59 PM
Contacts	Authorizing Official	Insert	New Registration		Soules, Tara Chief Financial Officer DSH230080-00 9897726818	4/2/2025 1:59 PM
Contacts	Primary Contact	Insert	New Registration		Harwood, Tiffany Corporate Director of 340B Data Analytics McLaren Health Care 7345128778	4/2/2025 1:59 PM
Details	Assistance Received From Date	Insert	New Registration			4/2/2025 1:59 PM
Details	Assistance Received To Date	Insert	New Registration			4/2/2025 1:59 PM
Details	Last Recertification Date	Insert	New Registration			4/2/2025 1:59 PM
Details	Grant Number	Insert	New Registration			4/2/2025 1:59 PM
Details	340B ID	Insert	New Registration			4/2/2025 1:59 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/2/2025 1:59 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/2/2025 1:59 PM
Details	Medicare Provider Number	Insert	New Registration		230080	4/2/2025 1:59 PM
Details	Entity Name	Insert	New Registration		MCLAREN CENTRAL MICHIGAN	4/2/2025 1:59 PM
Details	NOFO Number	Insert	New Registration			4/2/2025 1:59 PM
Details	Program Code	Insert	New Registration		DSH	4/2/2025 1:59 PM
Details	Entity Subname	Insert	New Registration		Gladwin Heart and Vascular	4/2/2025 1:59 PM
Dates	Participating Approval Date	Insert	New Registration			4/2/2025 1:59 PM
Details	State	Insert	New Registration		Pending	4/2/2025 1:59 PM
Dates	Registration Date	Insert	New Registration		4/2/2025 1:59:12 PM	4/2/2025 1:59 PM
Dates	Signed By Date	Insert	New Registration			4/2/2025 1:59 PM
Dates	Start Date	Insert	New Registration			4/2/2025 1:59 PM
Terminations	Termination Comments	Insert	New Registration			4/2/2025 1:59 PM
Terminations	Termination Date	Insert	New Registration			4/2/2025 1:59 PM
Terminations	Termination Effective Date	Insert	New Registration			4/2/2025 1:59 PM
Terminations	Termination Reason	Insert	New Registration			4/2/2025 1:59 PM