Covered Entity Details

DSH230021AV LAKELAND REGIONAL HEALTH SYSTEM LAKELAND MEDICAL CENTER ST JOSEPH DBA COREWELL HEALTH LAKELAND HOSPITALS (Approved) - information as of 6/24/2025 12:01:53 AM

Main Details

Name

LAKELAND REGIONAL HEALTH SYSTEM LAKELAND MEDICAL CENTER ST JOSEPH DBA COREWELL HEALTH LAKELAND HOSPITALS

Subdivision Name

COREWELL HEALTH LAKELAND HOSPITALS - Gastroenterology Practice

Type

Disproportionate Share Hospital

Rural

340B ID

DSH230021AV

Medicare Provider Number

230021

Outpatient Facility Provider Number

Additional Details

Current Program Status

Approved

Registration Date

4/14/2025

Participating Start Date

7/1/2025

Participating Approval Date

5/14/2025

Last Recertification Date

Contacts

Authorizing Official

Corewell Health
Hardik Dalal, SVP, Finance & System-wide Pharmacy Finance
(312) 771-0810

Primary Contact

Lakeland Regional Health DBA Corewell Health
Nicole Weston, Business Analyst
(269) 985-4431

Addresses

Street Address

3903 HOLLYWOOD RD
ST. JOSEPH, MI 49085-9149

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		1134220031

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
DSH230021A	Child	DSH	LAKELAND REGIONAL HEALTH SYSTEM LAKELAND MEDICAL CENTER ST JOSEPH	LAKELAND MEDICAL CENTER NILES	31 N ST JOSEPH AVENUE	NILES	MI	Terminated
DSH230021AA	Child	DSH	LAKELAND REGIONAL HEALTH SYSTEM LAKELAND MEDICAL CENTER ST JOSEPH DBA COREWELL HEALTH LAKELAND HOSPITALS	Endoscopy - Niles	31 N St Joseph Avenue	Niles	MI	Active
DSH230021AB	Child	DSH	LAKELAND REGIONAL HEALTH SYSTEM LAKELAND MEDICAL CENTER ST JOSEPH	Ambulatory Surgery - COPS	3900 Hollywood Rd	St Joseph	MI	Terminated
DSH230021AC	Child	DSH	LAKELAND REGIONAL HEALTH SYSTEM LAKELAND MEDICAL CENTER ST JOSEPH DBA COREWELL HEALTH LAKELAND HOSPITALS	Operating Room - Niles	31 N St Joseph Avenue	Niles	MI	Active
DSH230021AD	Child	DSH	LAKELAND REGIONAL HEALTH SYSTEM LAKELAND MEDICAL CENTER ST JOSEPH DBA COREWELL HEALTH LAKELAND HOSPITALS	Labor and Delivery - Niles	31 N St Joseph Avenue	Niles	MI	Active
DSH230021AE	Child	DSH	LAKELAND REGIONAL HEALTH SYSTEM LAKELAND MEDICAL CENTER ST JOSEPH DBA COREWELL HEALTH LAKELAND HOSPITALS	ICU - Niles	31 N St Joseph Avenue	Niles	MI	Active
DSH230021AF	Child	DSH	LAKELAND REGIONAL HEALTH SYSTEM LAKELAND MEDICAL CENTER ST JOSEPH DBA COREWELL HEALTH LAKELAND HOSPITALS	Obstetrics - Niles	31 N St Joseph Avenue	Niles	MI	Active
DSH230021AG	Child	DSH	LAKELAND REGIONAL HEALTH SYSTEM LAKELAND MEDICAL CENTER ST JOSEPH DBA COREWELL HEALTH LAKELAND HOSPITALS	Medical/Surgical - Niles A2/A3	31 N St Joseph Avenue	Niles	MI	Active
DSH230021AH	Child	DSH	LAKELAND REGIONAL HEALTH SYSTEM LAKELAND MEDICAL CENTER ST JOSEPH	Lakeland Cardiology Niles - Cardiology	61 N. St. Joseph Avenue	Niles	MI	Terminated
DSH230021AJ	Child	DSH	LAKELAND REGIONAL HEALTH SYSTEM LAKELAND MEDICAL CENTER ST JOSEPH DBA COREWELL HEALTH LAKELAND HOSPITALS	Niles EEG - Neurology	31 N. St. Joseph Avenue	Niles	MI	Active
DSH230021AK	Child	DSH	LAKELAND REGIONAL HEALTH SYSTEM LAKELAND MEDICAL CENTER ST JOSEPH DBA COREWELL HEALTH LAKELAND HOSPITALS	Niles Recovery - Surgery	31 N. St. Joseph Avenue	Niles	MI	Terminated
DSH230021AL	Child	DSH	LAKELAND REGIONAL HEALTH SYSTEM LAKELAND MEDICAL CENTER ST JOSEPH	Home Care Niles - Home Care	2 N. St. Joseph Avenue	Niles	MI	Terminated
DSH230021AM	Child	DSH	LAKELAND REGIONAL HEALTH SYSTEM LAKELAND MEDICAL CENTER ST JOSEPH DBA COREWELL HEALTH LAKELAND HOSPITALS	LAKELAND CANCER SPECIALISTS NILES - LCSP CANCER SPECIALISTS NILES	42 N. St. Joseph Avenue	NILES	MI	Active
DSH230021AN	Child	DSH	LAKELAND REGIONAL HEALTH SYSTEM LAKELAND MEDICAL CENTER ST JOSEPH DBA COREWELL HEALTH LAKELAND HOSPITALS	LAKELAND CANCER SPECIALISTS ST JOSEPH - LCSP CANCER SPECIALISTS ST JOE	3900 HOLLYWOOD ROAD	SAINT JOSEPH	MI	Active
DSH230021AP	Child	DSH	LAKELAND REGIONAL HEALTH SYSTEM LAKELAND MEDICAL CENTER ST JOSEPH DBA COREWELL HEALTH LAKELAND HOSPITALS	COPS - Sleep Diagnostic Practice	3950 Hollywood Rd	St Joseph	MI	Active
DSH230021AQ	Child	DSH	LAKELAND REGIONAL HEALTH SYSTEM LAKELAND MEDICAL CENTER ST JOSEPH DBA COREWELL HEALTH LAKELAND HOSPITALS	COPS - Neurology Practice	3950 Hollywood Rd	St Joseph	MI	Active
DSH230021AR	Child	DSH	LAKELAND REGIONAL HEALTH SYSTEM LAKELAND MEDICAL CENTER ST JOSEPH DBA COREWELL HEALTH LAKELAND HOSPITALS	COPS - Infectious Disease Practice	3950 Hollywood Rd	St Joseph	MI	Active
DSH230021AS	Child	DSH	LAKELAND REGIONAL HEALTH SYSTEM LAKELAND MEDICAL CENTER ST JOSEPH DBA COREWELL HEALTH LAKELAND HOSPITALS	COPS - Rheumatology Practice	3950 Hollywood Rd	St Joseph	MI	Active
DSH230021AT	Child	DSH	LAKELAND REGIONAL HEALTH SYSTEM LAKELAND MEDICAL CENTER ST JOSEPH DBA COREWELL HEALTH LAKELAND HOSPITALS	COPS - Diabetes and Endocrinology Practice	3950 Hollywood Rd	St Joseph	MI	Active
DSH230021AU	Child	DSH	LAKELAND REGIONAL HEALTH SYSTEM LAKELAND MEDICAL CENTER ST JOSEPH DBA COREWELL HEALTH LAKELAND HOSPITALS	Watervliet - Infusion Clinic	400 Medical Park Dr	Watervliet	MI	Active
DSH230021AV	Child	DSH	LAKELAND REGIONAL HEALTH SYSTEM LAKELAND MEDICAL CENTER ST JOSEPH DBA COREWELL HEALTH LAKELAND HOSPITALS	COREWELL HEALTH LAKELAND HOSPITALS - Gastroenterology Practice	3903 HOLLYWOOD RD	ST. JOSEPH	MI	Approved
DSH230021B	Child	DSH	LAKELAND REGIONAL HEALTH SYSTEM LAKELAND MEDICAL CENTER ST JOSEPH	LAKELAND CENTER FOR OUTPATIENT SERVICES - ST JOSEPH	3900 HOLLYWOOD ROAD	ST JOSEPH	MI	Terminated
DSH230021C	Child	DSH	LAKELAND REGIONAL HEALTH SYSTEM LAKELAND MEDICAL CENTER ST JOSEPH DBA COREWELL HEALTH LAKELAND HOSPITALS	LAKELAND ONCOLOGY CLINIC	3900 HOLLYWOOD ROAD	ST JOSEPH	MI	Terminated
DSH230021D	Child	DSH	LAKELAND REGIONAL HEALTH SYSTEM LAKELAND MEDICAL CENTER ST JOSEPH	LAKELAND HOMECARE	2550 MEADOWBROOK RD	BENTON HARBOR	MI	Terminated
DSH230021E	Child	DSH	LAKELAND REGIONAL HEALTH SYSTEM	Lakeland Home Infusion	2550 Meadowbrook Road	Benton Harbor	MI	Terminated
DSH230021F	Child	DSH	LAKELAND REGIONAL HEALTH SYSTEM LAKELAND MEDICAL CENTER ST JOSEPH DBA COREWELL HEALTH LAKELAND HOSPITALS	Respiratory Therapy - Niles	31 N St Joseph Avenue	Niles	MI	Active
DSH230021G	Child	DSH	LAKELAND REGIONAL HEALTH SYSTEM LAKELAND MEDICAL CENTER ST JOSEPH DBA COREWELL HEALTH LAKELAND HOSPITALS	Anesthesiology - Niles	31 N St Joseph Avenue	Niles	MI	Active
DSH230021H	Child	DSH	LAKELAND REGIONAL HEALTH SYSTEM LAKELAND MEDICAL CENTER ST JOSEPH DBA COREWELL HEALTH LAKELAND HOSPITALS	Cardiology and EKG - Niles	31 N St Joseph Avenue	Niles	MI	Active
DSH230021J	Child	DSH	LAKELAND REGIONAL HEALTH SYSTEM LAKELAND MEDICAL CENTER ST JOSEPH DBA COREWELL HEALTH LAKELAND HOSPITALS	Ultrasound - COPS	3900 Hollywood Road	St Joseph	MI	Active
DSH230021K	Child	DSH	LAKELAND REGIONAL HEALTH SYSTEM LAKELAND MEDICAL CENTER ST JOSEPH DBA COREWELL HEALTH LAKELAND HOSPITALS	Ultrasound - Niles	31 N St Joseph Avenue	Niles	MI	Active
DSH230021L	Child	DSH	LAKELAND REGIONAL HEALTH SYSTEM LAKELAND MEDICAL CENTER ST JOSEPH DBA COREWELL HEALTH LAKELAND HOSPITALS	CT Scanner - COPS	3900 Hollywood Road	St Joseph	MI	Active
DSH230021M	Child	DSH	LAKELAND REGIONAL HEALTH SYSTEM LAKELAND MEDICAL CENTER ST JOSEPH DBA COREWELL HEALTH LAKELAND HOSPITALS	CT Scanner - Niles	31 N St Joseph Avenue	Niles	MI	Active
DSH230021N	Child	DSH	LAKELAND REGIONAL HEALTH SYSTEM LAKELAND MEDICAL CENTER ST JOSEPH DBA COREWELL HEALTH LAKELAND HOSPITALS	MRI - COPS	3900 Hollywood Road	St Joseph	MI	Active
DSH230021P	Child	DSH	LAKELAND REGIONAL HEALTH SYSTEM LAKELAND MEDICAL CENTER ST JOSEPH DBA COREWELL HEALTH LAKELAND HOSPITALS	Nuclear Medicine - Niles	31 N St Joseph Avenue	Niles	MI	Active
DSH230021Q	Child	DSH	LAKELAND REGIONAL HEALTH SYSTEM LAKELAND MEDICAL CENTER ST JOSEPH DBA COREWELL HEALTH LAKELAND HOSPITALS	MRI - Niles	31 N St Joseph Avenue	Niles	MI	Active
DSH230021R	Child	DSH	LAKELAND REGIONAL HEALTH SYSTEM LAKELAND MEDICAL CENTER ST JOSEPH DBA COREWELL HEALTH LAKELAND HOSPITALS	PET Scan - COPS	3900 Hollywood Road	St Joseph	MI	Active
DSH230021S	Child	DSH	LAKELAND REGIONAL HEALTH SYSTEM LAKELAND MEDICAL CENTER ST JOSEPH DBA COREWELL HEALTH LAKELAND HOSPITALS	Radiology - COPS	3900 Hollywood Road	St Joseph	MI	Active
DSH230021T	Child	DSH	LAKELAND REGIONAL HEALTH SYSTEM LAKELAND MEDICAL CENTER ST JOSEPH DBA COREWELL HEALTH LAKELAND HOSPITALS	Radiology - Niles	31 N St Joseph Avenue	Niles	MI	Active
DSH230021U	Child	DSH	LAKELAND REGIONAL HEALTH SYSTEM LAKELAND MEDICAL CENTER ST JOSEPH DBA COREWELL HEALTH LAKELAND HOSPITALS	Sleep Lab - Niles	31 N St Joseph Avenue	Niles	MI	Active
DSH230021V	Child	DSH	LAKELAND REGIONAL HEALTH SYSTEM LAKELAND MEDICAL CENTER ST JOSEPH DBA COREWELL HEALTH LAKELAND HOSPITALS	Laboratroy - Niles	31 N St Joseph Avenue	Niles	MI	Terminated
DSH230021W	Child	DSH	LAKELAND REGIONAL HEALTH SYSTEM LAKELAND MEDICAL CENTER ST JOSEPH DBA COREWELL HEALTH LAKELAND HOSPITALS	LAKELAND CENTER FOR WOUND CARE AND	42 N SAINT JOSEPH AVE	NILES	MI	Active
DSH230021X	Child	DSH	LAKELAND REGIONAL HEALTH SYSTEM LAKELAND MEDICAL CENTER ST JOSEPH DBA COREWELL HEALTH LAKELAND HOSPITALS	Ambulatory Infusion - Niles	42 N St Joseph Avenue Suite 303	Niles	MI	Terminated
DSH230021Y	Child	DSH	LAKELAND REGIONAL HEALTH SYSTEM LAKELAND MEDICAL CENTER ST JOSEPH DBA COREWELL HEALTH LAKELAND HOSPITALS	Chest Pain Unit - Niles	31 N St Joseph Avenue	Niles	MI	Active
DSH230021Z	Child	DSH	LAKELAND REGIONAL HEALTH SYSTEM LAKELAND MEDICAL CENTER ST JOSEPH DBA COREWELL HEALTH LAKELAND HOSPITALS	Emergency Roon - Niles	31 N St Joseph Avenue	Niles	MI	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Signed By	Insert	New Registration		Dalal, Hardik SVP, Finance & System-wide Pharmacy Finance Corewell Health 3127710810	5/14/2025 2:10 PM
Details	340B ID	Update	New Registration		DSH230021AV	5/14/2025 2:10 PM
Details	Entity Name	Update	New Registration	COREWELL HEALTH LAKELAND HOSPITALS	LAKELAND REGIONAL HEALTH SYSTEM LAKELAND MEDICAL CENTER ST JOSEPH DBA COREWELL HEALTH LAKELAND HOSPITALS	5/14/2025 2:10 PM
Details	Entity Subname	Update	New Registration	COREWELL HEALTH LAKELAND HOSPITALS	COREWELL HEALTH LAKELAND HOSPITALS - Gastroenterology Practice	5/14/2025 2:10 PM
Dates	Participating Approval Date	Update	New Registration		5/14/2025 2:10:57 PM	5/14/2025 2:10 PM
Details	State	Update	New Registration	Pending	Approved	5/14/2025 2:10 PM
Dates	Signed By Date	Update	New Registration		4/15/2025 8:55:00 AM	5/14/2025 2:10 PM
Dates	Start Date	Update	New Registration		7/1/2025 12:00:00 AM	5/14/2025 2:10 PM
Addresses	Main Address	Insert	New Registration		3903 HOLLYWOOD RD ST. JOSEPH, MI 49085-9149	4/14/2025 9:37 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1134220031	4/14/2025 9:37 AM
Medicaid Billing	NPI: State	Insert	New Registration		MI	4/14/2025 9:37 AM
Contacts	Authorizing Official	Insert	New Registration		Dalal, Hardik SVP, Finance & System-wide Pharmacy Finance Corewell Health 3127710810	4/14/2025 9:37 AM
Contacts	Primary Contact	Insert	New Registration		Weston, Nicole Business Analyst Lakeland Regional Health DBA Corewell Health 2699854431	4/14/2025 9:37 AM
Details	Assistance Received From Date	Insert	New Registration			4/14/2025 9:37 AM
Details	Assistance Received To Date	Insert	New Registration			4/14/2025 9:37 AM
Details	Last Recertification Date	Insert	New Registration			4/14/2025 9:37 AM
Details	Grant Number	Insert	New Registration			4/14/2025 9:37 AM
Details	340B ID	Insert	New Registration			4/14/2025 9:37 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/14/2025 9:37 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/14/2025 9:37 AM
Details	Medicare Provider Number	Insert	New Registration		230021	4/14/2025 9:37 AM
Details	Entity Name	Insert	New Registration		COREWELL HEALTH LAKELAND HOSPITALS	4/14/2025 9:37 AM
Details	NOFO Number	Insert	New Registration			4/14/2025 9:37 AM
Details	Program Code	Insert	New Registration		DSH	4/14/2025 9:37 AM
Details	Entity Subname	Insert	New Registration		COREWELL HEALTH LAKELAND HOSPITALS	4/14/2025 9:37 AM
Dates	Participating Approval Date	Insert	New Registration			4/14/2025 9:37 AM
Details	State	Insert	New Registration		Pending	4/14/2025 9:37 AM
Dates	Registration Date	Insert	New Registration		4/14/2025 9:37:29 AM	4/14/2025 9:37 AM
Dates	Signed By Date	Insert	New Registration			4/14/2025 9:37 AM
Dates	Start Date	Insert	New Registration			4/14/2025 9:37 AM
Terminations	Termination Comments	Insert	New Registration			4/14/2025 9:37 AM
Terminations	Termination Date	Insert	New Registration			4/14/2025 9:37 AM
Terminations	Termination Effective Date	Insert	New Registration			4/14/2025 9:37 AM
Terminations	Termination Reason	Insert	New Registration			4/14/2025 9:37 AM