Covered Entity Details

CAH231338-03 SPECTRUM HEALTH GERBER (Terminated) - information as of 5/1/2025 11:52:08 PM

Main Details

Name

SPECTRUM HEALTH GERBER

Subdivision Name

Hesperia Medical Center

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH231338-03

Medicare Provider Number

231338

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

3/27/2015

Participating Start Date

4/1/2015

Participating Approval Date

3/31/2015

Last Recertification Date

9/6/2018

Termination Date
Termination Reason

10/1/2019
Hospital Outpatient facility no longer eligible

Contacts

Authorizing Official

Spectrum Health Gerber
John Sella, Senior Director, Finance
(616) 643-9168

Primary Contact

Spectrum Health
Angela Marie Knol, Business Intelligence Analyst
(616) 774-7939

Addresses

Street Address

78 N Division St.
Hesperia, MI 49421

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

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
		1396878773

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
CAH231338-01	Child	CAH	Corewell Health Gerber Hospital	Fremont Family and Walk-in (Main Street)	204 West Main St.	Fremont	MI	Active
CAH231338-02	Child	CAH	SPECTRUM HEALTH GERBER	Grant Medical Center	230 S Maple St.	Grant	MI	Terminated
CAH231338-03	Child	CAH	SPECTRUM HEALTH GERBER	Hesperia Medical Center	78 N Division St.	Hesperia	MI	Terminated
CAH231338-04	Child	CAH	Corewell Health Gerber Hospital	Cancer Center	230 W. Oak St.	Fremont	MI	Active
CAH231338-05	Child	CAH	Corewell Health Gerber Hospital	Multispecialty Clinic - Family Medicine	230 W Oak St.	Fremont	MI	Active
CAH231338-06	Child	CAH	Corewell Health Gerber Hospital	Ob/Gyn	212 S. Sullivan Ave.	Fremont	MI	Active
CAH231338-07	Child	CAH	Corewell Health Gerber Hospital	Family Medicine and Walk-in Clinic - Newaygo	211 W PINE LAKE DR	NEWAYGO	MI	Active
CAH231338-08	Child	CAH	Corewell Health Gerber Hospital	Multispecialty Clinic - Orthopedics	230 W Oak St	Fremont	MI	Active
CAH231338-09	Child	CAH	Corewell Health Gerber Hospital	Multispecialty Clinic - General Surgery	230 W Oak St	Fremont	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
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		6/28/2019 12:00:00 AM	7/9/2019 6:31 AM
Details	State	Update	Termination Request	Active	To Be Terminated	7/9/2019 6:31 AM
Terminations	Termination Date	Update	Termination Request		10/1/2019 12:00:00 AM	7/9/2019 6:31 AM
Terminations	Termination Effective Date	Update	Termination Request		7/1/2019 12:00:00 AM	7/9/2019 6:31 AM
Terminations	Termination Reason	Update	Termination Request		Hospital Outpatient facility no longer eligible	7/9/2019 6:31 AM
Contacts	Primary Contact	Update	Change Request	Foster, Ryan Wells Dir. Pharmacy Spectrum Health System - Grand Rapids, MI 6163913028	Knol, Angela Marie Business Intelligence Analyst Spectrum Health 6167747939	7/2/2019 10:52 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1396878773	9/6/2018 4:13 PM
Details	Last Recertification Date	Update	Recertification	11/10/2017 8:59:34 AM	9/6/2018 4:13:02 PM	9/6/2018 4:13 PM
Contacts	Authorizing Official	Update	Change Request	McClain, Brian Dir, Clinical/Ambulatory SVCS Spectrum health Gerber Memorial 2319241110	Sella, John Senior Director, Finance Spectrum Health Gerber 6166439168	7/26/2018 10:31 AM
Details	Last Recertification Date	Update	Recertification	10/26/2017 8:13:54 AM	11/10/2017 8:59:34 AM	11/10/2017 8:59 AM
Details	Last Recertification Date	Update	Recertification	9/1/2016 12:00:00 AM	10/26/2017 8:13:54 AM	10/26/2017 8:13 AM
Contacts	Authorizing Official	Update		McClain, Brian Dir, Clinical/Ambulatory SVCS 2319241110	McClain, Brian Dir, Clinical/Ambulatory SVCS Spectrum health Gerber Memorial 2319241110	10/2/2017 8:25 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	Primary Contact	Insert			Foster, Ryan Dir. Pharmacy 6163913028	7/28/2017 8:56 AM
Contacts	Signed By	Insert			Nichols, Kevin VP, Finance 2319241347	7/12/2017 11:14 AM
Contacts	Authorizing Official	Insert			McClain, Brian Dir, Clinical/Ambulatory SVCS 2319241110	7/12/2017 11:14 AM
Addresses	Main Address	Insert			78 N Division St. Hesperia, MI 49421	7/12/2017 11:14 AM
Details	Last Recertification Date	Update		8/25/2015 12:00:00 AM	9/1/2016 12:00:00 AM	9/1/2016 8:25 AM
Details	Last Recertification Date	Update			8/25/2015 12:00:00 AM	8/25/2015 1:14 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_50162	CAH231338-03	3/31/2015 3:32 PM
Dates	Participating Approval Date	Update			3/31/2015 12:00:00 AM	3/31/2015 3:32 PM
Details	State	Update		Pending	Active	3/31/2015 3:32 PM
Dates	Start Date	Update			4/1/2015 12:00:00 AM	3/31/2015 3:32 PM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_50162	3/27/2015 3:59 PM
Details	Last Recertification Date	Insert				3/27/2015 3:59 PM
Details	Grant Number	Insert				3/27/2015 3:59 PM
Details	340B ID	Insert				3/27/2015 3:59 PM
Details	Is Authorizing Official EHB Data	Insert				3/27/2015 3:59 PM
Dates	Last Date That 340B Drugs Purchased	Insert				3/27/2015 3:59 PM
Details	Medicare Provider Number	Insert			231338	3/27/2015 3:59 PM
Details	Entity Name	Insert			SPECTRUM HEALTH GERBER	3/27/2015 3:59 PM
Details	Program Code	Insert			CAH	3/27/2015 3:59 PM
Details	Entity Subname	Insert			Hesperia Medical Center	3/27/2015 3:59 PM
Dates	Participating Approval Date	Insert				3/27/2015 3:59 PM
Details	State	Insert			Pending	3/27/2015 3:59 PM
Dates	Registration Date	Insert			3/27/2015 12:00:00 AM	3/27/2015 3:59 PM
Dates	Signed By Date	Insert			3/27/2015 12:00:00 AM	3/27/2015 3:59 PM
Dates	Start Date	Insert				3/27/2015 3:59 PM
Terminations	Termination Comments	Insert				3/27/2015 3:59 PM
Terminations	Termination Date	Insert				3/27/2015 3:59 PM
Terminations	Termination Effective Date	Insert				3/27/2015 3:59 PM
Terminations	Termination Reason	Insert				3/27/2015 3:59 PM