| Details | Last Recertification Date | Update | Recertification | 8/16/2023 2:08:13 PM | 8/12/2024 9:40:08 AM | 8/12/2024 9:40 AM |
| Addresses | Billing Address | Insert | Recertification | | Marlette Regional Hospital
2770 Main Street
Marlette, MI 48453 | 8/16/2023 2:08 PM |
| Addresses | Shipping Address | Insert | Recertification | | Marlette Regional Hospital
2770 Main Street
Marlette, MI 48453 | 8/16/2023 2:08 PM |
| Details | Last Recertification Date | Update | Recertification | 8/24/2022 1:23:58 PM | 8/16/2023 2:08:13 PM | 8/16/2023 2:08 PM |
| Details | Last Recertification Date | Update | Recertification | 8/16/2021 10:40:15 AM | 8/24/2022 1:23:58 PM | 8/24/2022 1:23 PM |
| Details | Last Recertification Date | Update | Recertification | 8/28/2020 9:39:37 AM | 8/16/2021 10:40:15 AM | 8/16/2021 10:40 AM |
| Contacts | Primary Contact | Update | Profile Change Request | Bradley, Ian
Pharmacy Manager
Marlette Regional Hospital
9896304125 | Bradley, Ian
Pharmacy Manager
Marlette Regional Hospital
9896354125 | 11/10/2020 8:07 AM |
| Contacts | Primary Contact | Update | Change Request | Kuhn, Tim E
Pharmacy Manager
Marlette Regional Hospital
9896354132 | Bradley, Ian
Pharmacy Manager
Marlette Regional Hospital
9896304125 | 11/5/2020 6:49 AM |
| Details | Last Recertification Date | Update | Recertification | 8/19/2019 2:22:22 PM | 8/28/2020 9:39:37 AM | 8/28/2020 9:39 AM |
| Contacts | Authorizing Official | Update | Change Request | Singles, James L.
CFO
Marlette Regional Hospital
9896354230 | Gentner, Kim
CFO
Marlette
9896354230 | 6/18/2020 8:34 AM |
| Contacts | Primary Contact | Update | Change Request | Ligeski, Len
Pharmacy Manager
Marlette Regional Hospital
9896354125 | Kuhn, Tim E
Pharmacy Manager
Marlette Regional Hospital
9896354132 | 6/17/2020 6:15 AM |
| Details | Last Recertification Date | Update | Recertification | 8/20/2018 10:56:20 AM | 8/19/2019 2:22:22 PM | 8/19/2019 2:22 PM |
| Details | Last Recertification Date | Update | Recertification | 11/3/2017 7:30:37 AM | 8/20/2018 10:56:20 AM | 8/20/2018 10:56 AM |
| Details | Last Recertification Date | Update | Recertification | 10/26/2017 9:42:27 AM | 11/3/2017 7:30:37 AM | 11/3/2017 7:30 AM |
| Details | Last Recertification Date | Update | Recertification | 8/12/2016 12:00:00 AM | 10/26/2017 9:42:27 AM | 10/26/2017 9:42 AM |
| Contacts | Primary Contact | Update | Recertification | Ligeski, Len
Pharmacy Manager
9896354125 | Ligeski, Len
Pharmacy Manager
Marlette Regional Hospital
9896354125 | 10/26/2017 9:06 AM |
| Contacts | Authorizing Official | Update | | Singles, James L.
CFO
9896354230 | Singles, James L.
CFO
Marlette Regional Hospital
9896354230 | 10/18/2017 9:44 AM |
| Contacts | Signed By | Update | | Singles, James L.
CFO
9896354230 | Singles, James L.
CFO
Marlette Regional Hospital
9896354230 | 10/18/2017 9:44 AM |
| Contacts | Authorizing Official | Insert | | | Singles, James L.
CFO
9896354230 | 1/17/2017 8:14 AM |
| Contacts | Signed By | Insert | | | Singles, James L.
CFO
9896354230 | 1/17/2017 8:14 AM |
| Addresses | Main Address | Insert | | |
4472 Main Street
Brown City, MI 48416 | 8/12/2016 7:43 AM |
| Contacts | Primary Contact | Insert | | | Ligeski, Len
Pharmacy Manager
9896354125 | 8/12/2016 7:43 AM |
| Details | Last Recertification Date | Update | | 8/10/2015 12:00:00 AM | 8/12/2016 12:00:00 AM | 8/12/2016 7:43 AM |
| Details | Last Recertification Date | Update | | 8/11/2014 12:00:00 AM | 8/10/2015 12:00:00 AM | 8/10/2015 2:14 PM |
| Details | Last Recertification Date | Update | | | 8/11/2014 12:00:00 AM | 8/11/2014 8:12 AM |
| Dates | Participating Approval Date | Update | | | 11/8/2013 12:00:00 AM | 11/8/2013 1:36 PM |
| Details | State | Update | | Pending | Active | 11/8/2013 1:36 PM |
| Dates | Start Date | Update | | | 1/1/2014 12:00:00 AM | 11/8/2013 1:36 PM |
| Details | 340B ID | Update | | OUTPATIENT_ONLINE_REG | CAH231330-02 | 11/4/2013 11:13 AM |
| Details | Last Recertification Date | Insert | | | | 10/10/2013 8:58 AM |
| Details | Grant Number | Insert | | | | 10/10/2013 8:58 AM |
| Details | 340B ID | Insert | | | OUTPATIENT_ONLINE_REG | 10/10/2013 8:58 AM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 10/10/2013 8:58 AM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 10/10/2013 8:58 AM |
| Details | Medicare Provider Number | Insert | | | 231330 | 10/10/2013 8:58 AM |
| Details | Entity Name | Insert | | | Marlette Regional Hospital | 10/10/2013 8:58 AM |
| Details | Program Code | Insert | | | CAH | 10/10/2013 8:58 AM |
| Details | Entity Subname | Insert | | | Family Healthcare of Brown City | 10/10/2013 8:58 AM |
| Dates | Participating Approval Date | Insert | | | | 10/10/2013 8:58 AM |
| Details | State | Insert | | | Pending | 10/10/2013 8:58 AM |
| Dates | Registration Date | Insert | | | 10/10/2013 12:00:00 AM | 10/10/2013 8:58 AM |
| Dates | Signed By Date | Insert | | | 10/10/2013 12:00:00 AM | 10/10/2013 8:58 AM |
| Dates | Start Date | Insert | | | | 10/10/2013 8:58 AM |
| Terminations | Termination Comments | Insert | | | | 10/10/2013 8:58 AM |
| Terminations | Termination Date | Insert | | | | 10/10/2013 8:58 AM |
| Terminations | Termination Effective Date | Insert | | | | 10/10/2013 8:58 AM |
| Terminations | Termination Reason | Insert | | | | 10/10/2013 8:58 AM |