Covered Entity Details

DSH230038C Corewell Health Grand Rapids Hospitals Butterworth Hospital (Active) - information as of 4/28/2025 1:46:14 AM

Main Details

Name

Corewell Health Grand Rapids Hospitals Butterworth Hospital

Subdivision Name

Surgery - Lake Drive

Type

Disproportionate Share Hospital

Rural

340B ID

DSH230038C

Medicare Provider Number

230038

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

11/28/2006

Participating Start Date

1/1/2007

Participating Approval Date

11/28/2006

Last Recertification Date

8/20/2024

Contacts

Authorizing Official

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

Primary Contact

Corewell Health
Lacey Alviar, Business Intell Analyst, Sr
(616) 391-1179

Addresses

Street Address

4069 LAKE DRIVE SE
Suite 210
GRAND RAPIDS, MI 49546

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
7/20/07 - ADDED SHIP TO ADDRESS	11/28/2006

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		1922090554

Shipping Addresses

Shipping Address 1

Corewell Health Grand Rapids Hospitals Butterworth Hospital
100 Michigan St. NE
Grand Rapids, MI 49503

Shipping Address 2

Corewell Health Warehouse
2925 WALKENT
GRAND RAPIDS, MI 49544

Shipping Address 3

Corewell Health Blodgett Hospital
1840 Wealthy Street SE
Grand Rapids, MI 49506

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
DSH230038A	Child	DSH	SPECTRUM HEALTH HOSPITALS	SPECTRUM HEALTH-BLODGETT CAMPUS	1840 WEALTHY SE	GRAND RAPIDS	MI	Terminated
DSH230038AA	Child	DSH	Corewell Health Grand Rapids Hospitals Butterworth Hospital	Cardiovascular Imaging - Bradford	2900 Bradford NE	GRAND RAPIDS	MI	Active
DSH230038AB	Child	DSH	Corewell Health Grand Rapids Hospitals Butterworth Hospital	DEVOS CHILDREN'S HOSPITAL END STAGE	35 Michigan St NE	GRAND RAPIDS	MI	Active
DSH230038AC	Child	DSH	Corewell Health Grand Rapids Hospitals Butterworth Hospital	LHCP - Gynecology and Oncology	145 Michigan Street NE	Grand Rapids	MI	Terminated
DSH230038AD	Child	DSH	Corewell Health Grand Rapids Hospitals Butterworth Hospital	LHCP - Radiology	145 Michigan Street NE	Grand Rapids	MI	Active
DSH230038AE	Child	DSH	Corewell Health Grand Rapids Hospitals Butterworth Hospital	Sleep Disorder Center	4100 LAKE DRIVE SE	GRAND RAPIDS	MI	Active
DSH230038AF	Child	DSH	Corewell Health Grand Rapids Hospitals Butterworth Hospital	Adult BMT Clinic	145 MICHIGAN STREET NE	GRAND RAPIDS	MI	Active
DSH230038AH	Child	DSH	SPECTRUM HEALTH HOSPITALS	TRANSPLANT ADVANCED HEART TRANSPLANT	2900 BRADFORD Street NE	GRAND RAPIDS	MI	Terminated
DSH230038AJ	Child	DSH	Corewell Health Grand Rapids Hospitals Butterworth Hospital	Cardiovascular Imaging - Holland	602 Michigan Street	Holland	MI	Active
DSH230038AK	Child	DSH	Corewell Health Grand Rapids Hospitals Butterworth Hospital	HDVCH Congenital Cardiology	25 Michigan Street NE	Grand Rapids	MI	Active
DSH230038AL	Child	DSH	Corewell Health Grand Rapids Hospitals Butterworth Hospital	OB/GYN Residency Practice	330 Barclay Ave NE	Grand Rapids	MI	Active
DSH230038AM	Child	DSH	Corewell Health Grand Rapids Hospitals Butterworth Hospital	HDVCH - General Peds Clinic	275 Michigan St NE	Grand Rapids	MI	Active
DSH230038AN	Child	DSH	Corewell Health Grand Rapids Hospitals Butterworth Hospital	Heart and Lung Transplant Clinic	275 Michigan St NE	Grand Rapids	MI	Active
DSH230038AP	Child	DSH	Corewell Health Grand Rapids Hospitals Butterworth Hospital	Family Medicine Res Practice	275 Michigan Street NE	Grand Rapids	MI	Active
DSH230038AQ	Child	DSH	Corewell Health Grand Rapids Hospitals Butterworth Hospital	Advanced Heart Failure Clinic	2902 Bradford Street NE	Grand Rapids	MI	Active
DSH230038AR	Child	DSH	Corewell Health Grand Rapids Hospitals Butterworth Hospital	Surgery - Grand Haven Center	15100 WHITTAKER WAY	GRAND HAVEN	MI	Active
DSH230038AS	Child	DSH	Corewell Health Grand Rapids Hospitals Butterworth Hospital	Blodgett Campus - Pre/Post Op Recovery	1840 Wealthy Street SE	Grand Rapids	MI	Active
DSH230038AT	Child	DSH	Corewell Health Grand Rapids Hospitals Butterworth Hospital	Blodgett Campus - Endoscopy	1840 Wealthy Street SE	Grand Rapids	MI	Active
DSH230038AU	Child	DSH	Corewell Health Grand Rapids Hospitals Butterworth Hospital	Blodgett Campus - Sleep Lab	1840 Wealthy Street SE	Grand Rapids	MI	Active
DSH230038AV	Child	DSH	Corewell Health Grand Rapids Hospitals Butterworth Hospital	Blodgett Campus - General Infusion Clinic	1840 Wealthy Street SE	Grand Rapids	MI	Active
DSH230038AW	Child	DSH	Corewell Health Grand Rapids Hospitals Butterworth Hospital	LHCP - Nuclear Medicine	145 Michigan Street NE	Grand Rapids	MI	Active
DSH230038AX	Child	DSH	Corewell Health Grand Rapids Hospitals Butterworth Hospital	Internal Medicine - Residency Clinic	275 Michigan St NE	Grand Rapids	MI	Active
DSH230038AY	Child	DSH	Corewell Health Grand Rapids Hospitals Butterworth Hospital	Blodgett Campus - Nuclear Medicine	1840 Wealthy Street SE	Grand Rapids	MI	Active
DSH230038AZ	Child	DSH	Corewell Health Grand Rapids Hospitals Butterworth Hospital	HDVCH - Neurology	35 Michigan St NE	Grand Rapids	MI	Active
DSH230038B	Child	DSH	Corewell Health Grand Rapids Hospitals Butterworth Hospital	Endoscopy	4100 LAKE DRIVE SE	GRAND RAPIDS	MI	Active
DSH230038BA	Child	DSH	Corewell Health Grand Rapids Hospitals Butterworth Hospital	HDVCH - Pulmonology	35 Michigan St NE	Grand Rapids	MI	Active
DSH230038BB	Child	DSH	Corewell Health Grand Rapids Hospitals Butterworth Hospital	Grand Rapids - Diabetes	221 Michigan St NE	Grand Rapids	MI	Active
DSH230038BC	Child	DSH	Corewell Health Grand Rapids Hospitals Butterworth Hospital	Beltline ICC - Neurology	2750 E Beltline Ave NE	Grand Rapids	MI	Active
DSH230038BD	Child	DSH	Corewell Health Grand Rapids Hospitals Butterworth Hospital	HDVCH - Gastroenterology	35 Michigan St NE	Grand Rapids	MI	Active
DSH230038BE	Child	DSH	Corewell Health Grand Rapids Hospitals Butterworth Hospital	Grand Rapids - Gastroenterology	4100 Lake Dr SE	Grand Rapids	MI	Active
DSH230038BF	Child	DSH	Corewell Health Grand Rapids Hospitals Butterworth Hospital	Grand Rapids - Bariatric Clinic	4100 Lake Dr SE	Grand Rapids	MI	Active
DSH230038BG	Child	DSH	Corewell Health Grand Rapids Hospitals Butterworth Hospital	Grand Rapids - Pulmonary Clinic	4100 Lake Dr SE	Grand Rapids	MI	Active
DSH230038BH	Child	DSH	Corewell Health Grand Rapids Hospitals Butterworth Hospital	Summit Park - Rheumatology Clinic	3271 Clear Vista Ct NE	Grand Rapids	MI	Active
DSH230038BJ	Child	DSH	Corewell Health Grand Rapids Hospitals Butterworth Hospital	HDVCH - Endocrinology	35 Michigan St NE	Grand Rapids	MI	Active
DSH230038BK	Child	DSH	Corewell Health Grand Rapids Hospitals Butterworth Hospital	Grand Rapids - Cystic Fibrosis Clinic	4100 Lake Dr SE	Grand Rapids	MI	Active
DSH230038BL	Child	DSH	Corewell Health Grand Rapids Hospitals Butterworth Hospital	HDVCH - Outpatient Dialysis	35 Michigan St NE	Grand Rapids	MI	Active
DSH230038BM	Child	DSH	Corewell Health Grand Rapids Hospitals Butterworth Hospital	Summit Park - Allergy Immunology Clinic	3271 Clear Vista Ct NE	Grand Rapids	MI	Active
DSH230038BN	Child	DSH	Corewell Health Grand Rapids Hospitals Butterworth Hospital	Beltline ICC - Infusion	2750 E Beltline Ave NE	Grand Rapids	MI	Active
DSH230038BP	Child	DSH	Corewell Health Grand Rapids Hospitals Butterworth Hospital	HDVCH - Allergy Immunology	35 Michigan St NE	Grand Rapids	MI	Active
DSH230038BQ	Child	DSH	Corewell Health Grand Rapids Hospitals Butterworth Hospital	HDVCH - Rheumatology	35 Michigan St NE	Grand Rapids	MI	Active
DSH230038BR	Child	DSH	Corewell Health Grand Rapids Hospitals Butterworth Hospital	LHCP - Oncology & Hematology	145 Michigan St NE	Grand Rapids	MI	Active
DSH230038BS	Child	DSH	Corewell Health Grand Rapids Hospitals Butterworth Hospital	Grand Rapids - Cardiovascular Medicine	2900 Bradford St NE	Grand Rapids	MI	Active
DSH230038BT	Child	DSH	Corewell Health Grand Rapids Hospitals Butterworth Hospital	Grand Rapids - Sleep Medicine	4100 Lake Dr SE	Grand Rapids	MI	Active
DSH230038BU	Child	DSH	Corewell Health Grand Rapids Hospitals Butterworth Hospital	HDVCH - Biochemical Genetics	35 Michigan St NE	Grand Rapids	MI	Active
DSH230038BV	Child	DSH	Corewell Health Grand Rapids Hospitals Butterworth Hospital	HDVCH - Neurosurgery	35 Michigan St NE	Grand Rapids	MI	Active
DSH230038C	Child	DSH	Corewell Health Grand Rapids Hospitals Butterworth Hospital	Surgery - Lake Drive	4069 LAKE DRIVE SE	GRAND RAPIDS	MI	Active
DSH230038D	Child	DSH	SPECTRUM HEALTH HOSPITALS	SPECTRUM HEALTH-EAST PARIS SURGICAL CENTER	1000 EAST PARIS SE	GRAND RAPIDS	MI	Terminated
DSH230038E	Child	DSH	Corewell Health Grand Rapids Hospitals Butterworth Hospital	Surgery - South Pavilion	80 68TH Street SE	Grand Rapids	MI	Active
DSH230038H	Child	DSH	SPECTRUM HEALTH HOSPITALS	Wound Healing and Burn Clinic	221 MICHIGAN Street NE	Grand Rapids	MI	Terminated
DSH230038L	Child	DSH	Corewell Health Grand Rapids Hospitals Butterworth Hospital	LHCP - Infusion Clinic	145 Michigan St NE	Grand Rapids	MI	Active
DSH230038M	Child	DSH	SPECTRUM HEALTH HOSPITALS	Spectrum Health Blodgett Campus - WOC Clinic	1840 Wealthy SE	GRAND RAPIDS	MI	Terminated
DSH230038N	Child	DSH	SPECTRUM HEALTH HOSPITALS	Spectrum Health Blodgett Campus - Burn Clinic	221 Michigan St NE	GRAND RAPIDS	MI	Terminated
DSH230038P	Child	DSH	Spectrum Health System	Spectrum Health Blodgett Campus - Observation	1840 Wealthy SE	GRAND RAPIDS	MI	Terminated
DSH230038Q	Child	DSH	Corewell Health Grand Rapids Hospitals Butterworth Hospital	Blodgett Campus - Emergency	1840 Wealthy Street SE	Grand Rapids	MI	Active
DSH230038R	Child	DSH	Corewell Health Grand Rapids Hospitals Butterworth Hospital	Blodgett Campus - Electroencephalography	1840 Wealthy Street SE	Grand Rapids	MI	Active
DSH230038S	Child	DSH	Corewell Health Grand Rapids Hospitals Butterworth Hospital	Spectrum Health Blodgett Campus - Electrocardiology	1840 Wealthy SE	GRAND RAPIDS	MI	Active
DSH230038T	Child	DSH	Corewell Health Grand Rapids Hospitals Butterworth Hospital	Blodgett Campus - Radiology	1840 Wealthy Street SE	Grand Rapids	MI	Active
DSH230038U	Child	DSH	Corewell Health Grand Rapids Hospitals Butterworth Hospital	Blodgett Campus - Acute Rehabilitation	1840 Wealthy Street SE	Grand Rapids	MI	Active
DSH230038V	Child	DSH	Corewell Health Grand Rapids Hospitals Butterworth Hospital	Blodgett Campus - Respiratory Therapy	1840 Wealthy Street SE	Grand Rapids	MI	Active
DSH230038W	Child	DSH	Corewell Health Grand Rapids Hospitals Butterworth Hospital	Blodgett Campus - Recovery Room	1840 Wealthy Street SE	Grand Rapids	MI	Active
DSH230038X	Child	DSH	Corewell Health Grand Rapids Hospitals Butterworth Hospital	Blodgett Campus - Anesthesiology	1840 Wealthy Street SE	Grand Rapids	MI	Active
DSH230038Y	Child	DSH	Corewell Health Grand Rapids Hospitals Butterworth Hospital	Blodgett Campus - Surgery	1840 Wealthy Street SE	Grand Rapids	MI	Active
DSH230038Z	Child	DSH	Corewell Health Grand Rapids Hospitals Butterworth Hospital	Cardiovascular Imaging - West Pavilion	6105 Wilson Ave.	Wyoming	MI	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Profile Change Request	Dalal, Hardik SVP, Finance CHW Corewell Health 3127710810	Dalal, Hardik SVP, Finance & System-wide Pharmacy Finance Corewell Health 3127710810	2/24/2025 6:26 AM
Contacts	Primary Contact	Update	Group Change Request	Alviar, Lacey Business Intelligence Analyst Spectrum Health Hospital 6163911179	Alviar, Lacey Business Intell Analyst, Sr Corewell Health 6163911179	12/5/2024 6:49 AM
Details	Last Recertification Date	Update	Recertification	8/28/2023 4:30:46 PM	8/20/2024 4:52:50 PM	8/20/2024 4:52 PM
Addresses	Shipping Address	Update	Change Request	SPECTRUM HEALTH DOWNTOWN 2925 WALKENT GRAND RAPIDS, MI 49544	Corewell Health Warehouse 2925 WALKENT GRAND RAPIDS, MI 49544	12/11/2023 8:02 AM
Addresses	Shipping Address	Update	Change Request	Spectrum Health Hospitals 100 Michigan St. NE Grand Rapids, MI 49503	Corewell Health Grand Rapids Hospitals Butterworth Hospital 100 Michigan St. NE Grand Rapids, MI 49503	12/11/2023 8:02 AM
Addresses	Shipping Address	Update	Change Request	Spectrum Health Blodgett Hospital 1840 Wealthy SE Grand Rapids, MI 49506	Corewell Health Blodgett Hospital 1840 Wealthy Street SE Grand Rapids, MI 49506	12/11/2023 8:02 AM
Details	Entity Subname	Update	Change Request	SPECTRUM HEALTH-LAKE DRIVE SURGICAL CENTER	Surgery - Lake Drive	12/11/2023 8:02 AM
Details	Entity Name	Update	Change Request	Spectrum Health System	Corewell Health Grand Rapids Hospitals Butterworth Hospital	12/11/2023 8:01 AM
Details	Last Recertification Date	Update	Recertification	9/14/2022 12:42:14 PM	8/28/2023 4:30:46 PM	8/28/2023 4:30 PM
Contacts	Authorizing Official	Update	Change Request	Ulreich, Shawn VP Clinical Operations/CNE Spectrum Health Hospitals 6163911065	Dalal, Hardik SVP, Finance CHW Corewell Health 3127710810	2/7/2023 7:20 AM
Addresses	Shipping Address	Delete	Recertification	1840 Wealthy SE Grand Rapids, MI 49506		9/14/2022 12:42 PM
Addresses	Shipping Address	Insert	Recertification		Spectrum Health Blodgett Hospital 1840 Wealthy SE Grand Rapids, MI 49506	9/14/2022 12:42 PM
Details	Last Recertification Date	Update	Recertification	9/1/2021 4:41:29 PM	9/14/2022 12:42:14 PM	9/14/2022 12:42 PM
Details	Entity Name	Update	Change Request	SPECTRUM HEALTH HOSPITALS	Spectrum Health System	3/3/2022 8:52 AM
Contacts	Primary Contact	Update	Group Change Request	Knol, Angela Marie Business Intelligence Analyst Spectrum Health 6167747939	Alviar, Lacey Business Intelligence Analyst Spectrum Health Hospital 6163911179	11/22/2021 4:07 PM
Details	Last Recertification Date	Update	Recertification	9/5/2020 12:21:04 AM	9/1/2021 4:41:29 PM	9/1/2021 4:41 PM
Medicaid Billing	NPI: State	Update	Recertification		MI	9/5/2020 12:21 AM
Contacts	Primary Contact	Update	Recertification	Volk, Andrew Director, Pharmacy Business Operations, SHDS Spectrum Health 6162670072	Knol, Angela Marie Business Intelligence Analyst Spectrum Health 6167747939	9/5/2020 12:21 AM
Details	Last Recertification Date	Update	Recertification	9/4/2019 1:43:50 PM	9/5/2020 12:21:04 AM	9/5/2020 12:21 AM
Addresses	Main Address	Update	Recertification	4069 LAKE DRIVE SE GRAND RAPIDS, MI 49546	4069 LAKE DRIVE SE Suite 210 GRAND RAPIDS, MI 49546	9/4/2019 1:43 PM
Details	Last Recertification Date	Update	Recertification	9/11/2018 8:14:04 AM	9/4/2019 1:43:50 PM	9/4/2019 1:43 PM
Contacts	Primary Contact	Update	Change Request	Foster, Ryan Wells Dir. Pharmacy Spectrum Health System - Grand Rapids, MI 6163913028	Volk, Andrew Director, Pharmacy Business Operations, SHDS Spectrum Health 6162670072	7/11/2019 12:50 PM
Details	Last Recertification Date	Update	Recertification	11/29/2017 1:32:32 PM	9/11/2018 8:14:04 AM	9/11/2018 8:14 AM
Details	Last Recertification Date	Update	Recertification	9/5/2016 12:00:00 AM	11/29/2017 1:32:32 PM	11/29/2017 1:32 PM
Contacts	Authorizing Official	Update		Ulreich, Shawn VP Clinical Operations/CNE 6163911065	Ulreich, Shawn VP Clinical Operations/CNE Spectrum Health Hospitals 6163911065	10/12/2017 5:45 PM
Contacts	Primary Contact	Update		Foster, Ryan Dir. Pharmacy 6163913028	Foster, Ryan Wells Dir. Pharmacy Spectrum Health System - Grand Rapids, MI 6163913028	10/1/2017 2:52 PM
Contacts	Authorizing Official	Update		FIFER, JOSEPH VP FINANCE 6163912754	Ulreich, Shawn VP Clinical Operations/CNE 6163911065	8/11/2017 2:01 PM
Contacts	Primary Contact	Insert			Foster, Ryan Dir. Pharmacy 6163913028	7/28/2017 8:56 AM
Addresses	Main Address	Insert			4069 LAKE DRIVE SE GRAND RAPIDS, MI 49546	7/13/2017 6:49 PM
Addresses	Shipping Address	Insert			SPECTRUM HEALTH DOWNTOWN 2925 WALKENT GRAND RAPIDS, MI 49544	7/13/2017 6:49 PM
Addresses	Shipping Address	Insert			Spectrum Health Hospitals 100 Michigan St. NE Grand Rapids, MI 49503	7/13/2017 6:49 PM
Addresses	Shipping Address	Insert			1840 Wealthy SE Grand Rapids, MI 49506	7/13/2017 6:49 PM
Details	Last Recertification Date	Update		8/24/2015 12:00:00 AM	9/5/2016 12:00:00 AM	9/5/2016 9:36 AM
Details	Last Recertification Date	Update		8/26/2014 12:00:00 AM	8/24/2015 12:00:00 AM	8/24/2015 8:18 AM
Details	Last Recertification Date	Update		8/28/2013 12:00:00 AM	8/26/2014 12:00:00 AM	8/26/2014 6:43 AM
Medicaid Billing	NPI: Number	Insert			1922090554	3/23/2014 8:07 PM
Details	Last Recertification Date	Update		8/28/2013 1:02:24 PM	8/28/2013 12:00:00 AM	3/23/2014 8:07 PM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	8/28/2013 1:02:24 PM	8/28/2013 1:02 PM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	5/30/2012 7:37 AM
Contacts	Authorizing Official	Insert			FIFER, JOSEPH VP FINANCE 6163912754	4/25/2012 11:41 AM
Details	Last Recertification Date	Insert				11/28/2006 1:22 PM
Details	Grant Number	Insert				11/28/2006 1:22 PM
Details	340B ID	Insert			DSH230038C	11/28/2006 1:22 PM
Details	Is Authorizing Official EHB Data	Insert				11/28/2006 1:22 PM
Dates	Last Date That 340B Drugs Purchased	Insert				11/28/2006 1:22 PM
Details	Medicare Provider Number	Insert			230038	11/28/2006 1:22 PM
Details	Entity Name	Insert			SPECTRUM HEALTH HOSPITALS	11/28/2006 1:22 PM
Details	Program Code	Insert			DSH	11/28/2006 1:22 PM
Details	Entity Subname	Insert			SPECTRUM HEALTH-LAKE DRIVE SURGICAL CENTER	11/28/2006 1:22 PM
Dates	Participating Approval Date	Insert			11/28/2006 12:00:00 AM	11/28/2006 1:22 PM
Details	State	Insert			Active	11/28/2006 1:22 PM
Dates	Registration Date	Insert			11/28/2006 12:00:00 AM	11/28/2006 1:22 PM
Dates	Signed By Date	Insert			11/17/2006 12:00:00 AM	11/28/2006 1:22 PM
Dates	Start Date	Insert			1/1/2007 12:00:00 AM	11/28/2006 1:22 PM
Terminations	Termination Comments	Insert				11/28/2006 1:22 PM
Terminations	Termination Date	Insert				11/28/2006 1:22 PM
Terminations	Termination Effective Date	Insert				11/28/2006 1:22 PM
Terminations	Termination Reason	Insert				11/28/2006 1:22 PM
Details	Comments Public	Insert			7/20/07 - ADDED SHIP TO ADDRESS	11/28/2006 1:22 PM