| Contacts | Authorizing Official | Update | Change Request | Knuth, Amanda
Controller
Corewell Health
2315924305 | Knuth, Amanda
Finance Controller
Corewell Health
2315924305 | 10/28/2024 1:49 PM |
| Contacts | Primary Contact | Update | Change Request | Alviar, Lacey
Business Intelligence Analyst
Spectrum Health Hospital
6163911179 | Alviar, Lacey
Business Intell Analyst, Sr
Corewell Health
6163911179 | 10/24/2024 2:17 PM |
| Details | Last Recertification Date | Update | Recertification | 8/29/2023 3:10:25 PM | 8/22/2024 9:17:34 AM | 8/22/2024 9:17 AM |
| Details | Entity Name | Update | Change Request | SPECTRUM HEALTH UNITED HOSPITAL | Corewell Health Greenville Hospital | 9/19/2023 2:27 PM |
| Details | Last Recertification Date | Update | Recertification | 9/7/2022 8:15:30 PM | 8/29/2023 3:10:25 PM | 8/29/2023 3:10 PM |
| Contacts | Authorizing Official | Update | Change Request | Sella, John
Senior Director, Finance
Spectrum Health Gerber
6166439168 | Knuth, Amanda
Controller
Corewell Health
2315924305 | 11/7/2022 1:53 PM |
| Details | Last Recertification Date | Update | Recertification | 8/23/2021 10:58:13 AM | 9/7/2022 8:15:30 PM | 9/7/2022 8:15 PM |
| Contacts | Authorizing Official | Update | Change Request | Knoerl, Tom
Controller
Spectrum Health
2315924253 | Sella, John
Senior Director, Finance
Spectrum Health Gerber
6166439168 | 6/23/2022 2:23 PM |
| 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 | 11/23/2021 8:57 AM |
| Details | Last Recertification Date | Update | Recertification | 8/24/2020 12:02:04 PM | 8/23/2021 10:58:13 AM | 8/23/2021 10:58 AM |
| Medicaid Billing | NPI: State | Update | Recertification | | MI | 8/24/2020 12:02 PM |
| Details | Last Recertification Date | Update | Recertification | 9/5/2019 11:48:17 AM | 8/24/2020 12:02:04 PM | 8/24/2020 12:02 PM |
| Contacts | Authorizing Official | Update | Change Request | Mahar, Priscilla Kay
Chief Operating and Compliance Officer
Spectrum Health United and Kelsey Hospitals
6162256313 | Knoerl, Tom
Controller
Spectrum Health
2315924253 | 2/28/2020 2:03 PM |
| Contacts | Primary Contact | Update | Recertification | Volk, Andrew
Director, Pharmacy Business Operations, SHDS
Spectrum Health
6162670072 | Knol, Angela Marie
Business Intelligence Analyst
Spectrum Health
6167747939 | 9/5/2019 11:48 AM |
| Details | Last Recertification Date | Update | Recertification | 8/22/2018 12:44:47 PM | 9/5/2019 11:48:17 AM | 9/5/2019 11:48 AM |
| Contacts | Primary Contact | Update | Profile Change Request | Volk, Andrew
Director, Pharmacy Business Operations, SHDS
Spectrum Health
6162256838 | Volk, Andrew
Director, Pharmacy Business Operations, SHDS
Spectrum Health
6162670072 | 1/14/2019 9:43 AM |
| Contacts | Primary Contact | Update | Recertification | Foster, Ryan Wells
Dir. Pharmacy
Spectrum Health System - Grand Rapids, MI
6163913028 | Volk, Andrew
Director, Pharmacy Business Operations, SHDS
Spectrum Health
6162256838 | 8/22/2018 12:44 PM |
| Details | Last Recertification Date | Update | Recertification | 11/15/2017 9:44:47 PM | 8/22/2018 12:44:47 PM | 8/22/2018 12:44 PM |
| Details | Last Recertification Date | Update | Recertification | 8/30/2016 12:00:00 AM | 11/15/2017 9:44:47 PM | 11/15/2017 9:44 PM |
| Contacts | Authorizing Official | Update | Profile Change Request | Mahar, Priscilla Kay
Chief Clinical and Compliance Officer
Spectrum Health United and Kelsey Hospitals
6162256313 | Mahar, Priscilla Kay
Chief Operating and Compliance Officer
Spectrum Health United and Kelsey Hospitals
6162256313 | 11/13/2017 2:14 PM |
| Contacts | Authorizing Official | Update | | Mahar, Priscilla
Chief Clinical and Compliance Officer
6162256313 | Mahar, Priscilla Kay
Chief Clinical and Compliance Officer
Spectrum Health United and Kelsey Hospitals
6162256313 | 10/4/2017 11:20 AM |
| 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 | | BONIS, PAUL A.
PRESIDENT
6162256901 | Mahar, Priscilla
Chief Clinical and Compliance Officer
6162256313 | 7/28/2017 12:41 PM |
| Contacts | Primary Contact | Update | | CHRISTENSEN, HEATHER
DIRECTOR OF PHARMACY
6162256838 | Foster, Ryan
Dir. Pharmacy
6163913028 | 7/28/2017 8:56 AM |
| Addresses | Main Address | Insert | | |
615 S. BOWER STREET
GREENVILLE, MI 48838 | 8/30/2016 2:36 PM |
| Details | Last Recertification Date | Update | | 8/25/2015 12:00:00 AM | 8/30/2016 12:00:00 AM | 8/30/2016 2:36 PM |
| Details | Last Recertification Date | Update | | 9/3/2014 12:00:00 AM | 8/25/2015 12:00:00 AM | 8/25/2015 7:34 AM |
| Details | Last Recertification Date | Update | | 8/20/2013 12:00:00 AM | 9/3/2014 12:00:00 AM | 9/3/2014 12:53 PM |
| Medicaid Billing | NPI: Number | Insert | | | 1457304495 | 6/11/2014 9:06 AM |
| Details | Last Recertification Date | Update | | 7/1/2012 12:00:00 AM | 8/20/2013 12:00:00 AM | 8/20/2013 12:58 PM |
| Contacts | Primary Contact | Insert | | | CHRISTENSEN, HEATHER
DIRECTOR OF PHARMACY
6162256838 | 5/30/2012 7:53 AM |
| Details | Last Recertification Date | Update | | | 7/1/2012 12:00:00 AM | 5/30/2012 7:53 AM |
| Contacts | Authorizing Official | Insert | | | BONIS, PAUL A.
PRESIDENT
6162256901 | 3/29/2010 5:58 PM |
| Details | Last Recertification Date | Insert | | | | 3/29/2010 5:58 PM |
| Details | Grant Number | Insert | | | | 3/29/2010 5:58 PM |
| Details | 340B ID | Insert | | | DSH230035 | 3/29/2010 5:58 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 3/29/2010 5:58 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 3/29/2010 5:58 PM |
| Details | Medicare Provider Number | Insert | | | 230035 | 3/29/2010 5:58 PM |
| Details | Entity Name | Insert | | | SPECTRUM HEALTH UNITED HOSPITAL | 3/29/2010 5:58 PM |
| Details | Program Code | Insert | | | DSH | 3/29/2010 5:58 PM |
| Details | Entity Subname | Insert | | | | 3/29/2010 5:58 PM |
| Dates | Participating Approval Date | Insert | | | 1/20/2010 12:00:00 AM | 3/29/2010 5:58 PM |
| Details | State | Insert | | | Active | 3/29/2010 5:58 PM |
| Dates | Registration Date | Insert | | | 1/20/2010 12:00:00 AM | 3/29/2010 5:58 PM |
| Dates | Signed By Date | Insert | | | 9/21/2009 12:00:00 AM | 3/29/2010 5:58 PM |
| Dates | Start Date | Insert | | | 1/20/2010 12:00:00 AM | 3/29/2010 5:58 PM |
| Terminations | Termination Comments | Insert | | | | 3/29/2010 5:58 PM |
| Terminations | Termination Date | Insert | | | | 3/29/2010 5:58 PM |
| Terminations | Termination Effective Date | Insert | | | | 3/29/2010 5:58 PM |
| Terminations | Termination Reason | Insert | | | | 3/29/2010 5:58 PM |