Covered Entity Details

SCH230055-09 Dickinson County Healthcare System (Terminated) - information as of 5/20/2025 12:49:09 AM

Main Details

Name

Dickinson County Healthcare System

Subdivision Name

DICKINSON DERMATOLOGY CLINIC

Type

Sole Community Hospital

Rural

Yes

340B ID

SCH230055-09

Medicare Provider Number

230055

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

7/1/2013

Participating Start Date

7/1/2017

Participating Approval Date

8/26/2013

Last Recertification Date

8/29/2019

Termination Date
Termination Reason

10/1/2019
Site closure

Contacts

Authorizing Official

Dickinson County Healthcare System
Meghan Rossato, Performance Improvement, Operations and Analytics Director
(906) 776-5634

Primary Contact

Dickinson County Healthcare System
Laura Casanova, Manager of Pharmacy
(906) 776-5419

Addresses

Street Address

1711 S STEPHENSON AVE
115
IRON MOUNTAIN, MI 49801-3649

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
6/14/17 Participated starting 10/1/2013, terminated 10/1/2016. Reinstated 7/1/2017.	06/14/2017

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
No

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
SCH230055-01	Child	SCH	Dickinson County Healthcare System	Nordic Medical Center	W4243 M-69	Felch	MI	Terminated
SCH230055-02	Child	SCH	Dickinson County Healthcare System	Wausaukee Medical Center	536 Kenny Dr.	Wausaukee	WI	Terminated
SCH230055-03	Child	SCH	Marshfield Medical Center - Dickinson	Marshfield Medical Center - Dickinson Florence Center	1010 Olive Avenue	Florence	WI	Active
SCH230055-04	Child	SCH	Marshfield Medical Center - Dickinson	Marshfield Medical Center - Dickinson Family Medicine	1711 S. Stephenson Avenue	Iron Mountain	MI	Active
SCH230055-05	Child	SCH	Marshfield Medical Center - Dickinson	Marshfield Medical Center - Dickinson Primary Care	1711 S. Stephenson Avenue	Iron Mountain	MI	Active
SCH230055-06	Child	SCH	Marshfield Medical Center - Dickinson	Marshfield Medical Center - Dickinson Norway Family and Geriatric Center	500 Main Street	Norway	MI	Active
SCH230055-07	Child	SCH	Dickinson County Healthcare System	DICKINSON CARDIOLOGY	1711 S STEPHENSON AVE	Iron Mountain	MI	Terminated
SCH230055-08	Child	SCH	Dickinson County Healthcare System	Dickinson Diagnostic Neurology Clinic	1711 S. Stephenson Avenue	Iron Mountain	MI	Terminated
SCH230055-09	Child	SCH	Dickinson County Healthcare System	DICKINSON DERMATOLOGY CLINIC	1711 S STEPHENSON AVE	IRON MOUNTAIN	MI	Terminated
SCH230055-10	Child	SCH	Marshfield Medical Center - Dickinson	Marshfield Medical Center - Dickinson Podiatry Services	225 W H ST	Iron Mountain	MI	Active
SCH230055-11	Child	SCH	Marshfield Medical Center - Dickinson	Marshfield Medical Center - Dickinson Wound Healing & Hyperbaric Medicine	1707 S. Stephenson Avenue	Iron Mountain	MI	Active
SCH230055-12	Child	SCH	Marshfield Medical Center - Dickinson	Marshfield Medical Center - Dickinson Sleep Medicine Center	1100 S. Carpenter Avenue	Iron Mountain	MI	Active
SCH230055-13	Child	SCH	Marshfield Medical Center - Dickinson	Marshfield Medical Center - Dickinson Norway Center	N1667 US HIGHWAY 8	Norway	MI	Active
SCH230055-14	Child	SCH	Marshfield Medical Center - Dickinson	Marshfield Medical Center - Dickinson Internal Medicine and Nephrology	1711 S. Stephenson Avenue	Iron Mountain	MI	Active
SCH230055-15	Child	SCH	Marshfield Medical Center - Dickinson	Marshfield Medical Center - Dickinson Urology	1711 S. Stephenson Avenue	Iron Mountain	MI	Active
SCH230055-16	Child	SCH	Dickinson County Healthcare System	DICKINSON ENT CLINIC	1711 S STEPHENSON AVE	IRON MOUNTAIN	MI	Terminated
SCH230055-17	Child	SCH	Dickinson County Healthcare System	DICKINSON PULMONOLOGY CLINIC	1711 S Stephenson Avenue	Iron Mountain	MI	Terminated
SCH230055-18	Child	SCH	Marshfield Medical Center - Dickinson	Marshfield Medical Center - Dickinson Hematology Oncology	1721 S. Stephenson Avenue	Iron Mountain	MI	Active
SCH230055-19	Child	SCH	Marshfield Medical Center - Dickinson	Marshfield Medical Center - Dickinson Obstetrics & Gynecology	1721 S. Stephenson Avenue	Iron Mountain	MI	Active
SCH230055-20	Child	SCH	Marshfield Medical Center - Dickinson	Marshfield Medical Center - Dickinson Orthopedics	1711 S. Stephenson Ave.	Iron Mountain	MI	Active
SCH230055-21	Child	SCH	Marshfield Medical Center - Dickinson	Marshfield Medical Center - Dickinson Regional Heart Care Clinic	1711 S. Stephenson Ave.	Iron Mountain	MI	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	10/1/2019 12:05 AM
Details	State	Update	Termination Request	Active	To Be Terminated	9/27/2019 7:36 AM
Terminations	Termination Date	Update	Termination Request		10/1/2019 12:00:00 AM	9/27/2019 7:36 AM
Terminations	Termination Effective Date	Update	Termination Request		6/1/2018 12:00:00 AM	9/27/2019 7:36 AM
Terminations	Termination Reason	Update	Termination Request		Site closure	9/27/2019 7:36 AM
Contacts	Authorizing Official	Update	Profile Change Request	Rossato, Meghan Performance Improvement, Operations and Analytics Director Dickinson County Healthcare System 9067765827	Rossato, Meghan Performance Improvement, Operations and Analytics Director Dickinson County Healthcare System 9067765634	9/5/2019 3:34 PM
Details	Last Recertification Date	Update	Recertification	8/16/2018 4:22:53 PM	8/29/2019 12:47:20 PM	8/29/2019 12:47 PM
Contacts	Authorizing Official	Update	AO Change Request	Hadley, Susan Director of Nursing Dickinson County Healthcare System 9067765596	Rossato, Meghan Performance Improvement, Operations and Analytics Director Dickinson County Healthcare System 9067765827	8/15/2019 7:05 AM
Details	Last Recertification Date	Update	Recertification	11/16/2017 1:07:16 PM	8/16/2018 4:22:53 PM	8/16/2018 4:22 PM
Addresses	Main Address	Update	Change Request	1711 S STEPHENSON AVE 205 IRON MOUNTAIN, MI 49801-3649	1711 S STEPHENSON AVE 115 IRON MOUNTAIN, MI 49801-3649	1/4/2018 3:04 PM
Details	Entity Name	Update	Recertification	DICKINSON COUNTY HEALTHCARE SYSTEM	Dickinson County Healthcare System	11/29/2017 10:10 AM
Addresses	Main Address	Update	Recertification	1711 S STEPHENSON AVE 205 IRON MOUNTAIN, MI 49801-3649	1711 S STEPHENSON AVE 205 IRON MOUNTAIN, MI 49801-3649	11/16/2017 1:07 PM
Details	Last Recertification Date	Update	Recertification		11/16/2017 1:07:16 PM	11/16/2017 1:07 PM
Contacts	Authorizing Official	Update		Hadley, Susan Director of Nursing 9067765596	Hadley, Susan Director of Nursing Dickinson County Healthcare System 9067765596	10/2/2017 11:21 AM
Contacts	Primary Contact	Update		Casanova, Laura Manager of Pharmacy 9067765419	Casanova, Laura Manager of Pharmacy Dickinson County Healthcare System 9067765419	9/19/2017 1:53 PM
Contacts	Primary Contact	Update		Hanson, Debra A. Controller 9067765648	Casanova, Laura Manager of Pharmacy 9067765419	8/30/2017 12:44 PM
Contacts	Authorizing Official	Insert			Hadley, Susan Director of Nursing 9067765596	8/30/2017 12:44 PM
Contacts	Signed By	Insert			Sparpana, Eileen Chief Financial Officer 9067765506	6/14/2017 3:09 PM
Addresses	Main Address	Insert			1711 S STEPHENSON AVE 205 IRON MOUNTAIN, MI 49801-3649	6/14/2017 3:09 PM
Details	Last Recertification Date	Update		8/11/2015 12:00:00 AM		6/14/2017 12:02 PM
Dates	Last Date That 340B Drugs Purchased	Update		7/26/2016 12:00:00 AM		6/14/2017 12:02 PM
Details	Entity Name	Update		Dickinson County Healthcare System	DICKINSON COUNTY HEALTHCARE SYSTEM	6/14/2017 12:02 PM
Details	Entity Subname	Update		Dickinson Dermatology Clinic	DICKINSON DERMATOLOGY CLINIC	6/14/2017 12:02 PM
Details	State	Update		Terminated	Active	6/14/2017 12:02 PM
Dates	Start Date	Update		10/1/2013 12:00:00 AM	7/1/2017 12:00:00 AM	6/14/2017 12:02 PM
Terminations	Termination Date	Update		10/1/2016 12:00:00 AM		6/14/2017 12:02 PM
Terminations	Termination Effective Date	Update		7/26/2016 12:00:00 AM		6/14/2017 12:02 PM
Terminations	Termination Reason	Update		DSH percentage below statutory minimum		6/14/2017 12:02 PM
Details	Comments Public	Insert			6/14/17 Participated starting 10/1/2013, terminated 10/1/2016. Reinstated 7/1/2017.	6/14/2017 12:02 PM
Contacts	Primary Contact	Insert			Hanson, Debra A. Controller 9067765648	8/5/2016 3:22 PM
Dates	Last Date That 340B Drugs Purchased	Update			7/26/2016 12:00:00 AM	8/5/2016 3:20 PM
Details	State	Update		Active	Terminated	8/5/2016 3:20 PM
Terminations	Termination Date	Update			10/1/2016 12:00:00 AM	8/5/2016 3:20 PM
Terminations	Termination Effective Date	Update			7/26/2016 12:00:00 AM	8/5/2016 3:20 PM
Terminations	Termination Reason	Update			DSH percentage below statutory minimum	8/5/2016 3:20 PM
Details	Last Recertification Date	Update		8/20/2014 12:00:00 AM	8/11/2015 12:00:00 AM	8/11/2015 4:44 PM
Details	Last Recertification Date	Update			8/20/2014 12:00:00 AM	8/20/2014 2:29 PM
Details	340B ID	Update		ISJMSCH230055-09	SCH230055-09	8/26/2013 6:04 PM
Dates	Participating Approval Date	Update			8/26/2013 12:00:00 AM	8/26/2013 6:04 PM
Details	State	Update		Pending	Active	8/26/2013 6:04 PM
Dates	Start Date	Update			10/1/2013 12:00:00 AM	8/26/2013 6:04 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG	ISJMSCH230055-09	8/19/2013 6:21 PM
Details	Last Recertification Date	Insert				7/1/2013 3:04 PM
Details	Grant Number	Insert				7/1/2013 3:04 PM
Details	340B ID	Insert			OUTPATIENT_ONLINE_REG	7/1/2013 3:04 PM
Details	Is Authorizing Official EHB Data	Insert				7/1/2013 3:04 PM
Dates	Last Date That 340B Drugs Purchased	Insert				7/1/2013 3:04 PM
Details	Medicare Provider Number	Insert			230055	7/1/2013 3:04 PM
Details	Entity Name	Insert			Dickinson County Healthcare System	7/1/2013 3:04 PM
Details	Program Code	Insert			SCH	7/1/2013 3:04 PM
Details	Entity Subname	Insert			Dickinson Dermatology Clinic	7/1/2013 3:04 PM
Dates	Participating Approval Date	Insert				7/1/2013 3:04 PM
Details	State	Insert			Pending	7/1/2013 3:04 PM
Dates	Registration Date	Insert			7/1/2013 12:00:00 AM	7/1/2013 3:04 PM
Dates	Signed By Date	Insert			7/1/2013 12:00:00 AM	7/1/2013 3:04 PM
Dates	Start Date	Insert				7/1/2013 3:04 PM
Terminations	Termination Comments	Insert				7/1/2013 3:04 PM
Terminations	Termination Date	Insert				7/1/2013 3:04 PM
Terminations	Termination Effective Date	Insert				7/1/2013 3:04 PM
Terminations	Termination Reason	Insert				7/1/2013 3:04 PM