Covered Entity Details

DSH230021 LAKELAND REGIONAL HEALTH SYSTEM LAKELAND MEDICAL CENTER ST JOSEPH DBA COREWELL HEALTH LAKELAND HOSPITALS (Active) - information as of 5/20/2025 12:46:02 AM

Main Details

Name

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

Subdivision Name

LAKELAND HOSPITAL - ST JOSEPH

Type

Disproportionate Share Hospital

Rural

340B ID

DSH230021

Medicare Provider Number

230021

Additional Details

Current Program Status

Active

Registration Date

5/2/2008

Participating Start Date

10/1/2004

Participating Approval Date

5/2/2008

Last Recertification Date

8/20/2024

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

1234 NAPIER AVENUE
ST JOSEPH, MI 49085

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
12/8/04 UPDATED ENTITY NAME (WAS LAKELAND HOSPITALS AT NILES & ST JOSEPH INC); 12/8/04 ADDED MEDICAID#	01/21/2010

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	1555548,5171314	1134220031

Shipping Addresses

Shipping Address 1

LAKELAND REGIONAL HEALTH SYSTEM LAKELAND MEDICAL CENTER ST JOSEPH
1234 NAPIER AVENUE
ST JOSEPH, MI 49085

Shipping Address 2

SAFECOR HEALTH
4060 BUSINESS PARK DRIVE SUITE B
COLUMBUS, OH 43204

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	07/01/2019	10/01/2019		10/01/2019
Contract Detail	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	07/01/2019	10/01/2019	01/01/2024	01/03/2024
Contract Detail	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	07/01/2019	10/01/2019		10/01/2019
Contract Detail	ACCREDO HEALTH GROUP INC	39625 LEWIS DR	STE 800	NOVI	MI	48377-2962	01/03/2024	04/01/2024		04/01/2024
Contract Detail	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	07/01/2019	10/01/2019		10/01/2019
Contract Detail	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	07/01/2019	10/01/2019		10/01/2019
Contract Detail	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	07/01/2019	10/01/2019	10/11/2023	10/24/2023
Contract Detail	APEX DRUG STORES, INC.	RITE AID #4401	102 STATE ROAD	DOWAGIAC	MI	49047	07/12/2022	10/01/2022	06/22/2024	07/09/2024
Contract Detail	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	04/04/2025	07/01/2025		04/04/2025
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	01/05/2023	04/01/2023		04/01/2023
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	01/05/2023	04/01/2023		04/01/2023
Contract Detail	Lakeland Pharmacy Shoppe	3900 Hollywood Road		St. Joseph	MI	49085	07/06/2012	07/06/2012	02/05/2018	02/05/2018
Contract Detail	LAKELAND PHARMACY SHOPPE #2 - ST. JOSEPH	THE PHARMACY SHOPPE, INC.	1234 NAPIER AVE STE C101	SAINT JOSEPH	MI	49085	01/06/2022	04/01/2022	12/01/2022	01/05/2023
Contract Detail	MEIJER DISTRIBUTION INC #90	2721 WALKER AVE NW		GRAND RAPIDS	MI	49544	04/01/2020	07/01/2020		07/01/2020
Contract Detail	MEIJER INC #41	1920 PIPESTONE ROAD		BENTON HARBOR	MI	49022	04/01/2020	07/01/2020		07/01/2020
Contract Detail	MEIJER PHARMACY #251	5019 RED ARROW HIGHWAY		STEVENSVILLE	MI	49127	04/01/2020	07/01/2020		07/01/2020
Contract Detail	MEIJER PHARMACY #464	41255 COCA COLA DR.		BELLEVILLE	MI	48111-1827	04/01/2020	07/01/2020		07/01/2020
Contract Detail	MEIJER STORES LIMITED PARTNERSHIP	D/B/A MEIJER PHARMACY #463	1515 PROFIT DR.	FORT WAYNE	IN	46808	04/01/2020	07/01/2020		07/01/2020
Contract Detail	ONCOMED THE ONCOLOGY PHARMACY OF BUFFALO	D/B/A ONCO360	140 JOHN JAMES AUDUBON PKWY STE 101	AMHERST	NY	14228	10/20/2021	01/01/2022		01/01/2022
Contract Detail	RITE AID OF MICHIGAN, INC.	RITE AID #4236	11 SOUTH 11TH STREET	NILES	MI	49120	07/12/2022	10/01/2022	06/22/2024	07/09/2024
Contract Detail	RITE AID OF MICHIGAN, INC.	RITE AID #3368	612 SAINT JOSEPH AVENUE	BERRIEN SPRINGS	MI	49103	07/12/2022	10/01/2022	06/22/2024	07/09/2024
Contract Detail	RITE AID OF MICHIGAN, INC.	RITE AID #4237	715 EAST FRONT STREET	BUCHANAN	MI	49107	07/12/2022	10/01/2022	06/22/2024	07/09/2024
Contract Detail	RITE AID OF MICHIGAN, INC.	RITE AID #4238	3681 SHAWNEE ROAD	BRIDGMAN	MI	49106	07/12/2022	10/01/2022	06/22/2024	07/09/2024
Contract Detail	RITE AID OF MICHIGAN, INC.	RITE AID #4239	6535 PAW PAW AVENUE	COLOMA	MI	49038	07/12/2022	10/01/2022	06/22/2024	07/09/2024
Contract Detail	SINA DRUG LLC	DBA ONCO360	1985 MARCUS AVE STE 120	NEW HYDE PARK	NY	11042	10/20/2021	01/01/2022		01/01/2022
Contract Detail	SINA DRUG LLC	D/B/A ONCO 360	13410 EASTPOINT CENTRE DR STE 101	LOUISVILLE	KY	40223	10/20/2021	01/01/2022		01/01/2022
Contract Detail	THE PHARMACY SHOPPE, INC.	DBA COREWELL HEALTH RETAIL PHARMACY - ST	1234 NAPIER AVE STE B100	SAINT JOSEPH	MI	49085	10/04/2017	01/01/2018		01/06/2022
Contract Detail	WALGREEN CO	DBA: WALGREENS #11265	1710 W JOHN BEERS RD	STEVENSVILLE	MI	49127-9409	01/14/2014	04/01/2014		04/26/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03364	907 SOUTH 11TH ST	NILES	MI	49120	01/14/2014	04/01/2014		04/26/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04536	1260 HILLTOP RD	SAINT JOSEPH	MI	49085	01/14/2014	04/01/2014		04/26/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS #21347	4157 RED ARROW HWY	STEVENSVILLE	MI	49127	01/14/2014	04/01/2014		04/26/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 10078	875 E NAPIER AVE	BENTON HARBOR	MI	49022	01/14/2014	04/01/2014		04/26/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 09691	1100 PHOENIX ST	SOUTH HAVEN	MI	49090-7912	07/14/2015	10/01/2015		04/26/2017
Contract Detail	Walgreens Central Fill #21399	4132Plainfield Rd	Ste 110	Indianapolis	IN	46231-7021	01/17/2023	04/01/2023		04/01/2023
Contract Detail	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	01/14/2014	04/01/2014	07/10/2015	04/26/2017
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	04/04/2025	07/01/2025		04/04/2025
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	04/04/2025	07/01/2025		04/04/2025
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	04/04/2025	07/01/2025		04/04/2025
Contract Detail	WILLIAM BEAUMONT HOSPITAL	DBA COREWELL HEALTH SPECIALTY PHARMACY	41965 ECORSE RD STE 100	VAN BUREN TWP	MI	48111	10/14/2022	01/01/2023		01/01/2023
Contract Detail	WILLIAM BEAUMONT HOSPITAL	DBA COREWELL HEALTH HOME INFUSION	31157 WOODWARD AVE STE 101	ROYAL OAK	MI	48073	01/17/2023	04/01/2023		04/01/2023
Contract Detail	WILLIAM BEAUMONT HOSPITAL	DBA - COREWELL HEALTH WILLIAM BEAUMONT U	PHARMACY 3601 W 13 MILE RD	ROYAL OAK	MI	48073	10/15/2024	01/01/2025		01/01/2025

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	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
Addresses	Main Address	Update	Change Request	1234 NAPIER AVENUE ST JOSEPH, MI 49085-2158	1234 NAPIER AVENUE ST JOSEPH, MI 49085	11/1/2024 7:56 AM
Details	Last Recertification Date	Update	Recertification	8/30/2023 9:28:03 AM	8/20/2024 4:49:37 PM	8/20/2024 4:49 PM
Contacts	Primary Contact	Update	Change Request	Taylor, Michael Analyst Business Intell. Spectrum Health 2692628670	Weston, Nicole Business Analyst Lakeland Regional Health DBA Corewell Health 2699854431	7/10/2024 7:29 AM
Contacts	Authorizing Official	Update	Change Request	Baggio, Natalie Sr VP Clinical Operations Corewell Health 2178258212	Dalal, Hardik SVP, Finance CHW Corewell Health 3127710810	2/20/2024 8:08 AM
Contacts	Primary Contact	Update	Profile Change Request	Taylor, Michael 340B Coordinator Spectrum Health 2692628670	Taylor, Michael Analyst Business Intell. Spectrum Health 2692628670	12/27/2023 9:35 AM
Details	Entity Name	Update	Change Request	LAKELAND REGIONAL HEALTH SYSTEM LAKELAND MEDICAL CENTER ST JOSEPH	LAKELAND REGIONAL HEALTH SYSTEM LAKELAND MEDICAL CENTER ST JOSEPH DBA COREWELL HEALTH LAKELAND HOSPITALS	9/28/2023 8:53 AM
Details	Last Recertification Date	Update	Recertification	8/31/2022 4:14:28 PM	8/30/2023 9:28:03 AM	8/30/2023 9:28 AM
Contacts	Primary Contact	Update	PC Change Request	Taylor, Michael James 340B Coordinator Lakeland Regional Health 2692628670	Taylor, Michael 340B Coordinator Spectrum Health 2692628670	7/10/2023 7:05 AM
Contacts	Authorizing Official	Update	AO Change Request	Baggio, Natalie SVP, Patient Care Services CNE LKD Lakeland Regional Health 2178258212	Baggio, Natalie Sr VP Clinical Operations Corewell Health 2178258212	6/16/2023 8:39 AM
Contacts	Authorizing Official	Update	Change Request	Konopacki, Paul Vincent VP Finance & CFO Spectrum Health 2693137188-2693137188	Baggio, Natalie SVP, Patient Care Services CNE LKD Lakeland Regional Health 2178258212	12/16/2022 6:58 AM
Details	Last Recertification Date	Update	Recertification	8/19/2021 12:18:35 PM	8/31/2022 4:14:28 PM	8/31/2022 4:14 PM
Details	Last Recertification Date	Update	Recertification	8/20/2020 1:12:20 PM	8/19/2021 12:18:35 PM	8/19/2021 12:18 PM
Addresses	Shipping Address	Delete	Change Request	LAKELAND HOME INFUSION SERVICES 2550 MEADOWBROOK ROAD SUITE 106 BENTON HARBOR, MI 49022		6/10/2021 12:12 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	100275530A (IN)		6/10/2021 12:12 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	382156872002 (IL)		6/10/2021 12:12 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1134220031 (AL)		6/10/2021 12:12 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1134220031 (CA)		6/10/2021 12:12 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1134220031 (AR)		6/10/2021 12:12 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1134220031 (CO)		6/10/2021 12:12 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1134220031 (CT)		6/10/2021 12:12 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1134220031 (MA)		6/10/2021 12:12 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1134220031 (NC)		6/10/2021 12:12 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1134220031 (SC)		6/10/2021 12:12 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1134220031 (GA)		6/10/2021 12:12 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1134220031 (OK)		6/10/2021 12:12 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1134220031 (OH)		6/10/2021 12:12 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1134220031 (FL)		6/10/2021 12:12 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1134220031 (WI)		6/10/2021 12:12 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1134220031 (WY)		6/10/2021 12:12 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1134220031 (IN)		6/10/2021 12:12 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1134220031 (IL)		6/10/2021 12:12 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1134220031	10/12/2020 4:50 PM
Medicaid Billing	NPI: State	Insert	Change Request		IN	10/12/2020 4:50 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1134220031	10/12/2020 4:50 PM
Medicaid Billing	NPI: State	Insert	Change Request		IL	10/12/2020 4:50 PM
Contacts	Primary Contact	Update	Change Request	TAYLOR, MICHAEL J. 340B COORDINATOR Lakeland Health 2696871877	Taylor, Michael James 340B Coordinator Lakeland Regional Health 2692628670	9/10/2020 1:22 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1134220031	8/20/2020 1:12 PM
Medicaid Billing	NPI: State	Insert	Recertification		AL	8/20/2020 1:12 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1134220031	8/20/2020 1:12 PM
Medicaid Billing	NPI: State	Insert	Recertification		CA	8/20/2020 1:12 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1134220031	8/20/2020 1:12 PM
Medicaid Billing	NPI: State	Insert	Recertification		AR	8/20/2020 1:12 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1134220031	8/20/2020 1:12 PM
Medicaid Billing	NPI: State	Insert	Recertification		CO	8/20/2020 1:12 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1134220031	8/20/2020 1:12 PM
Medicaid Billing	NPI: State	Insert	Recertification		CT	8/20/2020 1:12 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1134220031	8/20/2020 1:12 PM
Medicaid Billing	NPI: State	Insert	Recertification		MA	8/20/2020 1:12 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1134220031	8/20/2020 1:12 PM
Medicaid Billing	NPI: State	Insert	Recertification		NC	8/20/2020 1:12 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1134220031	8/20/2020 1:12 PM
Medicaid Billing	NPI: State	Insert	Recertification		SC	8/20/2020 1:12 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1134220031	8/20/2020 1:12 PM
Medicaid Billing	NPI: State	Insert	Recertification		GA	8/20/2020 1:12 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1134220031	8/20/2020 1:12 PM
Medicaid Billing	NPI: State	Insert	Recertification		OK	8/20/2020 1:12 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1134220031	8/20/2020 1:12 PM
Medicaid Billing	NPI: State	Insert	Recertification		OH	8/20/2020 1:12 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1134220031	8/20/2020 1:12 PM
Medicaid Billing	NPI: State	Insert	Recertification		FL	8/20/2020 1:12 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1134220031	8/20/2020 1:12 PM
Medicaid Billing	NPI: State	Insert	Recertification		WI	8/20/2020 1:12 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1134220031	8/20/2020 1:12 PM
Medicaid Billing	NPI: State	Insert	Recertification		WY	8/20/2020 1:12 PM
Medicaid Billing	NPI: State	Update	Recertification		MI	8/20/2020 1:12 PM
Details	Last Recertification Date	Update	Recertification	8/22/2019 5:27:00 AM	8/20/2020 1:12:20 PM	8/20/2020 1:12 PM
Contacts	Authorizing Official	Update	AO Change Request	CALHOUN, TIM CFO Lakeland Hospitals 2699838398	Konopacki, Paul Vincent VP Finance & CFO Spectrum Health 2693137188-2693137188	6/9/2020 3:05 PM
Addresses	Shipping Address	Insert	Change Request		SAFECOR HEALTH 4060 BUSINESS PARK DRIVE SUITE B COLUMBUS, OH 43204	4/27/2020 8:20 AM
Addresses	Shipping Address	Insert	Change Request		LAKELAND REGIONAL HEALTH SYSTEM LAKELAND MEDICAL CENTER ST JOSEPH 1234 NAPIER AVENUE ST JOSEPH, MI 49085	4/6/2020 3:33 PM
Addresses	Shipping Address	Insert	Change Request		LAKELAND HOME INFUSION SERVICES 2550 MEADOWBROOK ROAD SUITE 106 BENTON HARBOR, MI 49022	4/6/2020 3:33 PM
Details	Entity Name	Update	Change Request	LAKELAND REGIONAL HEALTH SYSTEM	LAKELAND REGIONAL HEALTH SYSTEM LAKELAND MEDICAL CENTER ST JOSEPH	3/17/2020 10:38 AM
Details	Last Recertification Date	Update	Recertification	8/16/2018 7:54:54 AM	8/22/2019 5:27:00 AM	8/22/2019 5:27 AM
Contacts	Primary Contact	Update	Profile Change Request	TAYLOR, MICHAEL J. 340B COORDINATOR Lakeland Health 2699854509	TAYLOR, MICHAEL J. 340B COORDINATOR Lakeland Health 2696871877	7/15/2019 7:29 AM
Details	Last Recertification Date	Update	Recertification	11/9/2017 7:59:47 AM	8/16/2018 7:54:54 AM	8/16/2018 7:54 AM
Details	Last Recertification Date	Update	Recertification	8/16/2016 12:00:00 AM	11/9/2017 7:59:47 AM	11/9/2017 7:59 AM
Contacts	Authorizing Official	Update		CALHOUN, TIM CFO 2699838398	CALHOUN, TIM CFO Lakeland Hospitals 2699838398	9/28/2017 12:42 PM
Contacts	Primary Contact	Update		TAYLOR, MICHAEL J. 340B COORDINATOR 2699854509	TAYLOR, MICHAEL J. 340B COORDINATOR Lakeland Health 2699854509	9/25/2017 12:53 PM
Contacts	Primary Contact	Update		WYANT, KURT D. PHARMACY MANAGER 2699838236	TAYLOR, MICHAEL J. 340B COORDINATOR 2699854509	8/2/2017 10:12 AM
Contacts	Authorizing Official	Insert			CALHOUN, TIM CFO 2699838398	8/2/2017 10:12 AM
Addresses	Main Address	Insert			1234 NAPIER AVENUE ST JOSEPH, MI 49085-2158	6/23/2017 7:02 AM
Medicaid Billing	NPI: Number	Insert			1134220031	6/23/2017 7:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	6/22/2017 12:54 PM
Medicaid Billing	Medicaid: Number	Insert			5171314	6/22/2017 12:54 PM
Medicaid Billing	Medicaid: State	Insert			MI	6/22/2017 12:54 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	6/20/2017 7:49 AM
Medicaid Billing	Medicaid: Number	Insert			100275530A	6/20/2017 7:49 AM
Medicaid Billing	Medicaid: State	Insert			IN	6/20/2017 7:49 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	6/20/2017 7:49 AM
Medicaid Billing	Medicaid: Number	Insert			382156872002	6/20/2017 7:49 AM
Medicaid Billing	Medicaid: State	Insert			IL	6/20/2017 7:49 AM
Contacts	Primary Contact	Update		JOHNSON, NEIL PHARMACY MANAGER 2699838494	WYANT, KURT D. PHARMACY MANAGER 2699838236	8/16/2016 8:36 AM
Details	Last Recertification Date	Update		8/6/2015 12:00:00 AM	8/16/2016 12:00:00 AM	8/16/2016 8:36 AM
Medicaid Billing	Medicaid: Is Primary	Update		True	False	9/8/2015 6:53 AM
Contacts	Primary Contact	Insert			JOHNSON, NEIL PHARMACY MANAGER 2699838494	9/8/2015 6:53 AM
Details	Last Recertification Date	Update		8/11/2014 12:00:00 AM	8/6/2015 12:00:00 AM	9/8/2015 6:53 AM
Details	Last Recertification Date	Update		8/19/2013 12:00:00 AM	8/11/2014 12:00:00 AM	8/11/2014 12:36 PM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	8/19/2013 12:00:00 AM	8/19/2013 9:19 PM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	5/30/2012 7:45 AM
Medicaid Billing	Medicaid: Number	Update		15555548	1555548	2/23/2012 6:35 PM
Details	Last Recertification Date	Insert				1/21/2010 3:42 PM
Details	Grant Number	Insert				1/21/2010 3:42 PM
Details	340B ID	Insert			DSH230021	1/21/2010 3:42 PM
Details	Is Authorizing Official EHB Data	Insert				1/21/2010 3:42 PM
Dates	Last Date That 340B Drugs Purchased	Insert				1/21/2010 3:42 PM
Details	Medicare Provider Number	Insert			230021	1/21/2010 3:42 PM
Details	Entity Name	Insert			LAKELAND REGIONAL HEALTH SYSTEM	1/21/2010 3:42 PM
Details	Program Code	Insert			DSH	1/21/2010 3:42 PM
Details	Entity Subname	Insert			LAKELAND HOSPITAL - ST JOSEPH	1/21/2010 3:42 PM
Dates	Participating Approval Date	Insert			5/2/2008 12:00:00 AM	1/21/2010 3:42 PM
Details	State	Insert			Active	1/21/2010 3:42 PM
Dates	Registration Date	Insert			5/2/2008 12:00:00 AM	1/21/2010 3:42 PM
Dates	Signed By Date	Insert				1/21/2010 3:42 PM
Dates	Start Date	Insert			10/1/2004 12:00:00 AM	1/21/2010 3:42 PM
Terminations	Termination Comments	Insert				1/21/2010 3:42 PM
Terminations	Termination Date	Insert				1/21/2010 3:42 PM
Terminations	Termination Effective Date	Insert				1/21/2010 3:42 PM
Terminations	Termination Reason	Insert				1/21/2010 3:42 PM
Details	Comments Public	Insert			12/8/04 UPDATED ENTITY NAME (WAS LAKELAND HOSPITALS AT NILES & ST JOSEPH INC); 12/8/04 ADDED MEDICAID#	1/21/2010 3:42 PM
Medicaid Billing	Medicaid: Is Primary	Insert			True	5/2/2008 3:32 PM
Medicaid Billing	Medicaid: Number	Insert			15555548	5/2/2008 3:32 PM
Medicaid Billing	Medicaid: State	Insert			MI	5/2/2008 3:32 PM