Covered Entity Details

DSH230207AD McLaren Oakland (Active) - information as of 4/30/2025 10:53:43 PM

Main Details

Name

McLaren Oakland

Subdivision Name

MCLAREN BREAST CENTER

Type

Disproportionate Share Hospital

Rural

340B ID

DSH230207AD

Medicare Provider Number

230207

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/15/2016

Participating Start Date

4/1/2016

Participating Approval Date

3/8/2016

Last Recertification Date

8/26/2024

Contacts

Authorizing Official

McLaren Oakland
Lynn Marcotte, CFO
(248) 338-5691

Primary Contact

McLaren Health Care
Tiffany Harwood, Corporate Director of 340B Data Analytics
(734) 512-8778

Addresses

Street Address

5701 BOW POINTE DRIVE
Suite 255
CLARKSTON, MI 48346-5402

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
MI		1376564088

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
DSH230207A	Child	DSH	McLaren Oakland	Mclaren Oakland - Clarkston Oncology	5680 Bow Pointe Drive	Clarkston	MI	Active
DSH230207AA	Child	DSH	McLaren Oakland	McLaren Oakland Baldwin Family Medicine (Residency Clinic)	1701 Baldwin Avenue	Pontiac	MI	Terminated
DSH230207AB	Child	DSH	McLaren Oakland	MCLAREN OAKLAND PHYSICAL THERAPY	5701 BOW POINTE DRIVE	CLARKSTON	MI	Active
DSH230207AC	Child	DSH	McLaren Oakland	MCLAREN WOUND CENTER	50 N Perry St	Pontiac	MI	Terminated
DSH230207AD	Child	DSH	McLaren Oakland	MCLAREN BREAST CENTER	5701 BOW POINTE DRIVE	CLARKSTON	MI	Active
DSH230207AE	Child	DSH	McLaren Oakland	MCLAREN SLEEP DIAGNOSTIC CENTER	5701 BOW POINTE DRIVE	CLARKSTON	MI	Terminated
DSH230207AF	Child	DSH	McLaren Oakland	MCLAREN OAKLAND WATERFORD FAM MED	3901 HIGHLAND ROAD	WATERFORD	MI	Terminated
DSH230207AG	Child	DSH	McLaren Oakland	McLaren Oakland Comprehensive Breast Center Clarkston - Breast Center	5701 Bow Pointe Dr	Clarkston	MI	Active
DSH230207AH	Child	DSH	McLaren Oakland	MCLAREN OAKLAND - Oxford Oncology	385 N LAPEER RD	OXFORD	MI	Active
DSH230207B	Child	DSH	McLaren Oakland	Mclaren Oakland - Macomb Oncology	1080 Harrington Blvd.	Mt. Clemens	MI	Active
DSH230207C	Child	DSH	McLaren Oakland	Mclaren Oakland - Lapeer Oncology	1295 Barry Drive	Lapeer	MI	Active
DSH230207D	Child	DSH	McLaren Oakland	Clarkston ER	5701 Bow Pointe	Clarkston	MI	Active
DSH230207E	Child	DSH	McLaren Oakland	McLaren Oakland - Oxford Medical Center Emergency Department	385 North Lapeer Rd.	Oxford	MI	Active
DSH230207F	Child	DSH	McLaren Oakland	Mclaren Oakland - Back Care and Pain Management	5625 Water Tower Place	Clarkston	MI	Active
DSH230207G	Child	DSH	McLaren Oakland	Mclaren Oakland - Oxford Premier Occupational Health	385 North Lapeer Rd.	Oxford	MI	Terminated
DSH230207H	Child	DSH	McLaren Oakland	Mclaren Oakland - Oxford Family Practice	385 North Lapeer Rd.	Oxford	MI	Active
DSH230207J	Child	DSH	McLaren Oakland	Mclaren Oakland - Oxford Specialty Clinic	385 North Lapeer Rd	Oxford	MI	Terminated
DSH230207L	Child	DSH	McLaren Oakland	McLaren Clarkston Internal Medicine	6507 Town Center Drive	Clarkston	MI	Terminated
DSH230207M	Child	DSH	McLaren Oakland	McLaren Dixie	6815 Dixie Hwy., Ste 1	Clarkston	MI	Terminated
DSH230207N	Child	DSH	McLaren Oakland	McLaren Lake Orion	1240 South Lapeer Road	Lake Orion	MI	Active
DSH230207P	Child	DSH	McLaren Oakland	McLaren Ortonville	180 North Ortonville Road	Ortonville	MI	Active
DSH230207R	Child	DSH	McLaren Oakland	McLaren Puno	4000 Highland Road,	Waterford	MI	Terminated
DSH230207T	Child	DSH	McLaren Oakland	McLaren Baldwin Akers	1701 Baldwin Road, Ste 102	Pontiac	MI	Terminated
DSH230207V	Child	DSH	McLaren Oakland	McLaren Bloomfield Oncology	43097 Woodward Ave.	Bloomfield Hills	MI	Terminated
DSH230207W	Child	DSH	McLaren Oakland	McLaren Oakland - Children's Health Services	673 MARTIN LUTHER KING JR BLVD N	PONTIAC	MI	Terminated
DSH230207X	Child	DSH	McLaren Oakland	McLaren Oakland - Baybrooke	950 UNIVERSITY DR	PONTIAC	MI	Terminated
DSH230207Y	Child	DSH	McLaren Oakland	McLaren Oakland - Drayton Primary Care	4400 DIXIE HIGHWAY	WATERFORD	MI	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Medicaid Billing	NPI: Number	Delete	Group Change Request	1790055143 (MI)		12/13/2024 12:53 PM
Details	Last Recertification Date	Update	Recertification	9/6/2023 11:06:04 AM	8/26/2024 1:08:33 PM	8/26/2024 1:08 PM
Contacts	Primary Contact	Update	PC 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 7:11 AM
Details	Last Recertification Date	Update	Recertification	9/13/2022 4:12:07 PM	9/6/2023 11:06:04 AM	9/6/2023 11:06 AM
Details	Last Recertification Date	Update	Recertification	8/26/2021 9:16:26 AM	9/13/2022 4:12:07 PM	9/13/2022 4:12 PM
Details	Last Recertification Date	Update	Recertification	9/9/2020 12:24:56 PM	8/26/2021 9:16:26 AM	8/26/2021 9:16 AM
Contacts	Primary Contact	Update	Profile Change Request	Brown, Sharelle Dir of Pharmacy McLaren Oakland 2483385479	Brown, Sharelle Corporate, 340B Program Director McLaren Health Care 2483968085	1/15/2021 11:38 AM
Contacts	Signed By	Update		KORTE, FRED CFO 2483385691	KORTE, FRED CFO McLaren Flint 2483385691	12/16/2020 10:22 AM
Medicaid Billing	NPI: State	Update	Recertification		MI	9/9/2020 12:24 PM
Medicaid Billing	NPI: State	Update	Recertification		MI	9/9/2020 12:24 PM
Details	Last Recertification Date	Update	Recertification	8/23/2019 12:14:14 PM	9/9/2020 12:24:56 PM	9/9/2020 12:24 PM
Details	Last Recertification Date	Update	Recertification	9/5/2018 12:10:46 PM	8/23/2019 12:14:14 PM	8/23/2019 12:14 PM
Addresses	Main Address	Update	Recertification	5701 BOW POINTE DR 255 CLARKSTON, MI 48346-5402	5701 BOW POINTE DRIVE Suite 255 CLARKSTON, MI 48346-5402	9/5/2018 12:10 PM
Details	Last Recertification Date	Update	Recertification	12/5/2017 5:23:52 PM	9/5/2018 12:10:46 PM	9/5/2018 12:10 PM
Contacts	Authorizing Official	Update	AO Change Request	Dimond, Margaret Ann CEO McLaren Oakland 2483385379	Marcotte, Lynn CFO McLaren Oakland 2483385691	6/28/2018 2:04 PM
Contacts	Authorizing Official	Update	AO Change Request	LeGault, Matthew CFO McLaren Oakland 2483385691	Dimond, Margaret Ann CEO McLaren Oakland 2483385379	3/26/2018 9:02 AM
Details	Entity Name	Update	Recertification	MCLAREN OAKLAND	McLaren Oakland	12/5/2017 7:29 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1376564088 (MI)		12/5/2017 5:23 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1790055143 (MI)		12/5/2017 5:23 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1376564088	12/5/2017 5:23 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1790055143	12/5/2017 5:23 PM
Details	Last Recertification Date	Update	Recertification	8/16/2016 12:00:00 AM	12/5/2017 5:23:52 PM	12/5/2017 5:23 PM
Contacts	Authorizing Official	Update		LeGault, Matthew CFO 2483385691	LeGault, Matthew CFO McLaren Oakland 2483385691	10/19/2017 2:40 PM
Contacts	Primary Contact	Update		Brown, Sharelle Dir of Pharmacy 2483385479	Brown, Sharelle Dir of Pharmacy McLaren Oakland 2483385479	10/19/2017 2:39 PM
Contacts	Signed By	Insert			KORTE, FRED CFO 2483385691	5/22/2017 9:47 AM
Contacts	Authorizing Official	Insert			LeGault, Matthew CFO 2483385691	5/22/2017 9:47 AM
Contacts	Primary Contact	Insert			Brown, Sharelle Dir of Pharmacy 2483385479	5/22/2017 9:47 AM
Addresses	Main Address	Insert			5701 BOW POINTE DR 255 CLARKSTON, MI 48346-5402	5/11/2017 3:43 PM
Medicaid Billing	Medicaid: Number	Update		13760564088	1376564088	8/16/2016 8:09 AM
Details	Last Recertification Date	Update			8/16/2016 12:00:00 AM	8/16/2016 8:09 AM
Dates	Participating Approval Date	Update			3/8/2016 12:00:00 AM	3/8/2016 1:01 PM
Details	State	Update		Pending	Active	3/8/2016 1:01 PM
Dates	Start Date	Update			4/1/2016 12:00:00 AM	3/8/2016 1:01 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_58179	DSH230207AD	2/22/2016 11:34 AM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_58179	1/15/2016 10:34 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	1/15/2016 10:34 AM
Medicaid Billing	Medicaid: Number	Insert			13760564088	1/15/2016 10:34 AM
Medicaid Billing	Medicaid: State	Insert			MI	1/15/2016 10:34 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	1/15/2016 10:34 AM
Medicaid Billing	Medicaid: Number	Insert			1790055143	1/15/2016 10:34 AM
Medicaid Billing	Medicaid: State	Insert			MI	1/15/2016 10:34 AM
Details	Last Recertification Date	Insert				1/15/2016 10:34 AM
Details	Grant Number	Insert				1/15/2016 10:34 AM
Details	340B ID	Insert				1/15/2016 10:34 AM
Details	Is Authorizing Official EHB Data	Insert				1/15/2016 10:34 AM
Dates	Last Date That 340B Drugs Purchased	Insert				1/15/2016 10:34 AM
Details	Medicare Provider Number	Insert			230207	1/15/2016 10:34 AM
Details	Entity Name	Insert			MCLAREN OAKLAND	1/15/2016 10:34 AM
Details	Program Code	Insert			DSH	1/15/2016 10:34 AM
Details	Entity Subname	Insert			MCLAREN BREAST CENTER	1/15/2016 10:34 AM
Dates	Participating Approval Date	Insert				1/15/2016 10:34 AM
Details	State	Insert			Pending	1/15/2016 10:34 AM
Dates	Registration Date	Insert			1/15/2016 12:00:00 AM	1/15/2016 10:34 AM
Dates	Signed By Date	Insert			1/15/2016 12:00:00 AM	1/15/2016 10:34 AM
Dates	Start Date	Insert				1/15/2016 10:34 AM
Terminations	Termination Comments	Insert				1/15/2016 10:34 AM
Terminations	Termination Date	Insert				1/15/2016 10:34 AM
Terminations	Termination Effective Date	Insert				1/15/2016 10:34 AM
Terminations	Termination Reason	Insert				1/15/2016 10:34 AM