| Addresses | Main Address | Update | Change Request |
2900 COLLINS RD.
LANSING MI 489100, MI 48910 |
2900 COLLINS RD.
LANSING, MI 48910 | 4/15/2025 6:38 AM |
| Details | State | Update | | Approved | Active | 4/1/2025 12:01 AM |
| Addresses | Main Address | Update | Hospital Type Change Request |
2900 Collins Rd
LANSING, MI 48910 |
2900 COLLINS RD.
LANSING MI 489100, MI 48910 | 2/3/2025 11:27 AM |
| Details | Last Recertification Date | Update | Hospital Type Change Request | 8/26/2024 8:40:10 AM | | 2/3/2025 11:27 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | Hospital Type Change Request | 1/1/2025 12:00:00 AM | | 2/3/2025 11:27 AM |
| Dates | Participating Approval Date | Update | Hospital Type Change Request | 3/14/2016 12:00:00 AM | 2/3/2025 11:27:46 AM | 2/3/2025 11:27 AM |
| Details | State | Update | Hospital Type Change Request | Terminated | Approved | 2/3/2025 11:27 AM |
| Dates | Registration Date | Update | Hospital Type Change Request | 1/15/2016 12:00:00 AM | 1/3/2025 11:01:33 AM | 2/3/2025 11:27 AM |
| Dates | Signed By Date | Update | Hospital Type Change Request | 1/15/2016 12:00:00 AM | 1/30/2025 9:13:35 AM | 2/3/2025 11:27 AM |
| Dates | Start Date | Update | Hospital Type Change Request | 4/1/2016 12:00:00 AM | 4/1/2025 12:00:00 AM | 2/3/2025 11:27 AM |
| Terminations | Termination Date | Update | Hospital Type Change Request | 1/1/2025 12:00:00 AM | | 2/3/2025 11:27 AM |
| Terminations | Termination Effective Date | Update | Hospital Type Change Request | 1/1/2025 12:00:00 AM | | 2/3/2025 11:27 AM |
| Terminations | Termination Reason | Update | Hospital Type Change Request | Change of covered entity type | | 2/3/2025 11:27 AM |
| Details | Comments Public | Insert | Hospital Type Change Request | | Participating Start Date 4/1/2016, Termination 1/1/2025, Reinstatement 4/1/2025 | 2/3/2025 11:24 AM |
| Details | State | Update | | To Be Terminated | Terminated | 1/1/2025 12:01 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | Hospital Type Change Request | | 1/1/2025 12:00:00 AM | 11/4/2024 1:20 PM |
| Details | State | Update | Hospital Type Change Request | Active | To Be Terminated | 11/4/2024 1:20 PM |
| Terminations | Termination Date | Update | Hospital Type Change Request | | 1/1/2025 12:00:00 AM | 11/4/2024 1:20 PM |
| Terminations | Termination Effective Date | Update | Hospital Type Change Request | | 1/1/2025 12:00:00 AM | 11/4/2024 1:20 PM |
| Terminations | Termination Reason | Update | Hospital Type Change Request | | Change of covered entity type | 11/4/2024 1:20 PM |
| Details | Last Recertification Date | Update | Recertification | 9/8/2023 2:18:24 PM | 8/26/2024 8:40:10 AM | 8/26/2024 8:40 AM |
| Contacts | Primary Contact | Update | Change Request | Brown, Sharelle
Corporate, 340B Program Director
McLaren Health Care
2483968085 | Harwood, Tiffany
Corporate Director of 340B Data Analytics
McLaren Health Care
7345128778 | 2/29/2024 11:09 AM |
| Details | Last Recertification Date | Update | Recertification | 9/15/2022 9:27:12 AM | 9/8/2023 2:18:24 PM | 9/8/2023 2:18 PM |
| Details | Last Recertification Date | Update | Recertification | 9/14/2021 7:34:58 AM | 9/15/2022 9:27:12 AM | 9/15/2022 9:27 AM |
| Contacts | Primary Contact | Update | PC Change Request | Ekola, Marla
Director of Pharmacy
McLaren Greater Lansing
5179757942 | Brown, Sharelle
Corporate, 340B Program Director
McLaren Health Care
2483968085 | 5/17/2022 8:31 AM |
| Addresses | Main Address | Update | Change Request |
401 WEST GREENLAWN AVE.
LANSING, MI 48910 |
2900 Collins Rd
LANSING, MI 48910 | 3/1/2022 8:27 AM |
| Details | Last Recertification Date | Update | Recertification | 9/15/2020 8:31:15 AM | 9/14/2021 7:34:58 AM | 9/14/2021 7:34 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Recertification | | False | 9/15/2020 8:31 AM |
| Medicaid Billing | Medicaid: Number | Insert | Recertification | | 5171065 | 9/15/2020 8:31 AM |
| Medicaid Billing | Medicaid: State | Insert | Recertification | | MI | 9/15/2020 8:31 AM |
| Medicaid Billing | NPI: State | Update | Recertification | | MI | 9/15/2020 8:31 AM |
| Details | Last Recertification Date | Update | Recertification | 9/12/2019 3:25:45 PM | 9/15/2020 8:31:15 AM | 9/15/2020 8:31 AM |
| Medicaid Billing | NPI: Number | Delete | Change Request | 1720028475 ( ) | | 2/13/2020 9:30 AM |
| Details | Last Recertification Date | Update | Recertification | 9/5/2018 11:08:47 AM | 9/12/2019 3:25:45 PM | 9/12/2019 3:25 PM |
| Contacts | Primary Contact | Update | Change Request | Cosson, Ron
Service Line Administrator, Clinical Support
Ingham Regional Medical Center
5179757555 | Ekola, Marla
Director of Pharmacy
McLaren Greater Lansing
5179757942 | 4/9/2019 9:34 AM |
| Details | Last Recertification Date | Update | Recertification | 12/1/2017 3:16:41 PM | 9/5/2018 11:08:47 AM | 9/5/2018 11:08 AM |
| Details | Last Recertification Date | Update | Recertification | 9/7/2016 12:00:00 AM | 12/1/2017 3:16:41 PM | 12/1/2017 3:16 PM |
| Details | Entity Name | Update | Recertification | INGHAM REGIONAL MEDICAL CENTER dba MCLAREN GREATER LANSING | MCLAREN GREATER LANSING | 12/1/2017 3:16 PM |
| Contacts | Authorizing Official | Update | | Thompson, Dale
Chief Financial Officer
5179757555 | Thompson, Dale
Chief Financial Officer
McLaren Greater Lansing
5179757555 | 12/1/2017 10:16 AM |
| Contacts | Signed By | Update | | Thompson, Dale
Chief Financial Officer
5179757555 | Thompson, Dale
Chief Financial Officer
McLaren Greater Lansing
5179757555 | 12/1/2017 10:16 AM |
| Contacts | Primary Contact | Update | | Cosson, Ron
Service Line Administrator, Clinical Support
5179757555 | Cosson, Ron
Service Line Administrator, Clinical Support
Ingham Regional Medical Center
5179757555 | 9/29/2017 12:36 PM |
| Contacts | Primary Contact | Insert | | | Cosson, Ron
Service Line Administrator, Clinical Support
5179757555 | 8/2/2017 10:13 AM |
| Contacts | Authorizing Official | Insert | | | Thompson, Dale
Chief Financial Officer
5179757555 | 8/2/2017 10:13 AM |
| Contacts | Signed By | Insert | | | Thompson, Dale
Chief Financial Officer
5179757555 | 8/2/2017 10:13 AM |
| Addresses | Main Address | Insert | | |
401 WEST GREENLAWN AVE.
LANSING, MI 48910 | 12/8/2016 2:14 PM |
| Details | Entity Name | Update | | INGHAM REGIONAL MEDICAL CENTER | INGHAM REGIONAL MEDICAL CENTER dba MCLAREN GREATER LANSING | 9/21/2016 11:17 AM |
| Details | Last Recertification Date | Update | | | 9/7/2016 12:00:00 AM | 9/7/2016 2:18 PM |
| Medicaid Billing | NPI: Number | Insert | | | 1720028475 | 4/15/2016 4:23 PM |
| Dates | Participating Approval Date | Update | | | 3/14/2016 12:00:00 AM | 3/14/2016 5:47 PM |
| Details | State | Update | | Pending | Active | 3/14/2016 5:47 PM |
| Dates | Start Date | Update | | | 4/1/2016 12:00:00 AM | 3/14/2016 5:47 PM |
| Details | 340B ID | Update | | ONLINE_REG_58164 | DSH230167 | 1/26/2016 12:39 PM |
| Details | 340B ID | Update | | | ONLINE_REG_58164 | 1/15/2016 10:09 AM |
| Medicaid Billing | NPI: Number | Insert | | | 1134104672 | 1/15/2016 10:09 AM |
| Details | Last Recertification Date | Insert | | | | 1/15/2016 10:09 AM |
| Details | Grant Number | Insert | | | | 1/15/2016 10:09 AM |
| Details | 340B ID | Insert | | | | 1/15/2016 10:09 AM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 1/15/2016 10:09 AM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 1/15/2016 10:09 AM |
| Details | Medicare Provider Number | Insert | | | 230167 | 1/15/2016 10:09 AM |
| Details | Entity Name | Insert | | | INGHAM REGIONAL MEDICAL CENTER | 1/15/2016 10:09 AM |
| Details | Program Code | Insert | | | DSH | 1/15/2016 10:09 AM |
| Details | Entity Subname | Insert | | | | 1/15/2016 10:09 AM |
| Dates | Participating Approval Date | Insert | | | | 1/15/2016 10:09 AM |
| Details | State | Insert | | | Pending | 1/15/2016 10:09 AM |
| Dates | Registration Date | Insert | | | 1/15/2016 12:00:00 AM | 1/15/2016 10:09 AM |
| Dates | Signed By Date | Insert | | | 1/15/2016 12:00:00 AM | 1/15/2016 10:09 AM |
| Dates | Start Date | Insert | | | | 1/15/2016 10:09 AM |
| Terminations | Termination Comments | Insert | | | | 1/15/2016 10:09 AM |
| Terminations | Termination Date | Insert | | | | 1/15/2016 10:09 AM |
| Terminations | Termination Effective Date | Insert | | | | 1/15/2016 10:09 AM |
| Terminations | Termination Reason | Insert | | | | 1/15/2016 10:09 AM |