Covered Entity Details

DSH230121U The Memorial Hospital d/b/a Memorial Healthcare (Active) - information as of 6/4/2025 12:07:44 PM

Main Details

Name

The Memorial Hospital d/b/a Memorial Healthcare

Subdivision Name

Memorial Healthcare Family Medicine- Corunna

Type

Disproportionate Share Hospital

Rural

340B ID

DSH230121U

Medicare Provider Number

230121

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

4/13/2016

Participating Start Date

7/1/2016

Participating Approval Date

4/26/2016

Last Recertification Date

9/6/2024

Contacts

Authorizing Official

Memorial Healthcare
Jorri Tremain, Chief Financial Officer
(989) 729-4466

Primary Contact

Memorial Healthcare
Tessa Luna, 340B Coordinator
(989) 721-2349

Addresses

Street Address

239 N STATE RD
101
OWOSSO, MI 48867

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	1557687,5171252	1063414233,1093198624,1316008006,1386101566,1013655414,1558105692

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
DSH230121A	Child	DSH	The Memorial Hospital d/b/a Memorial Healthcare	Memorial Healthcare Cancer Center	721 N Shiawassee St	Owosso	MI	Active
DSH230121AA	Child	DSH	The Memorial Hospital d/b/a Memorial Healthcare	Memorial Healthcare Family Medicine Main Street	1975 W M 21	Owosso	MI	Terminated
DSH230121AB	Child	DSH	The Memorial Hospital d/b/a Memorial Healthcare	Memorial Healthcare Family Medicine- Perry	3337 W. Britton Rd	Perry	MI	Active
DSH230121AC	Child	DSH	The Memorial Hospital d/b/a Memorial Healthcare	Memorial Healthcare Family Medicine- Durand	9099 E Lansing Rd	Durand	MI	Active
DSH230121AD	Child	DSH	The Memorial Hospital d/b/a Memorial Healthcare	Memorial Healthcare Wound Management	818 W King St	Owosso	MI	Active
DSH230121AE	Child	DSH	The Memorial Hospital d/b/a Memorial Healthcare	Memorial Healthcare Urology- Main Campus- Mitchell	802 W. King St	Owosso	MI	Terminated
DSH230121AF	Child	DSH	The Memorial Hospital d/b/a Memorial Healthcare	Memorial Heatlhcare OB/GYN	818 W. King St	Owosso	MI	Active
DSH230121AG	Child	DSH	The Memorial Hospital d/b/a Memorial Healthcare	Memorial Healthcare Pain Management	818 W KING ST	OWOSSO	MI	Active
DSH230121AH	Child	DSH	The Memorial Hospital d/b/a Memorial Healthcare	Memorial Healthcare Gastroenterology- Flint	1123 VILLA LINDE CT	FLINT	MI	Terminated
DSH230121AJ	Child	DSH	The Memorial Hospital d/b/a Memorial Healthcare	Memorial Healthcare Institute for Neuroscience- St. Johns	1501 Waterford Pkwy	St. Johns	MI	Terminated
DSH230121AK	Child	DSH	The Memorial Hospital d/b/a Memorial Healthcare	Memorial Healthcare Ophthalmology	802 W. King St.	Owosso	MI	Active
DSH230121AL	Child	DSH	The Memorial Hospital d/b/a Memorial Healthcare	Memorial Healthcare Orthopedics, Sports Medicine, & Rehabilitation- Main Campus	819 N. Shiawassee St	Owosso	MI	Active
DSH230121AM	Child	DSH	The Memorial Hospital d/b/a Memorial Healthcare	Memorial Healthcare Family Medicine/ Memorial Healthcare Occupational Medicine- Shiawassee	208 N. Shiawassee St.	Owosso	MI	Terminated
DSH230121AN	Child	DSH	The Memorial Hospital d/b/a Memorial Healthcare	Memorial Healthcare Allergy & Immunology	317 S. Elm St	Owosso	MI	Active
DSH230121AP	Child	DSH	The Memorial Hospital d/b/a Memorial Healthcare	INSTITUTE FOR NEUROSCIENCE OKEMOS - INSTITUTE FOR NEUROSCIENCE OKEMOS	2525 JOLLY RD	OKEMOS	MI	Active
DSH230121AQ	Child	DSH	The Memorial Hospital d/b/a Memorial Healthcare	MHC ANTICOAGULATION CLINIC - ANTICOAGULATION CLINIC	721 N. Shiawassee St.	Owosso	MI	Active
DSH230121AR	Child	DSH	The Memorial Hospital d/b/a Memorial Healthcare	MH PHYSICAL MEDICINE & REHAB - PHYSICAL MEDICINE & REHAB	819 N SHIAWASSEE ST	OWOSSO	MI	Active
DSH230121AS	Child	DSH	The Memorial Hospital d/b/a Memorial Healthcare	MHC INFUSION CENTER - MHC INFUSION CENTER	721 N. Shiawassee St.	Owosso	MI	Active
DSH230121AT	Child	DSH	The Memorial Hospital d/b/a Memorial Healthcare	MH PHYSICAL MEDICINE&REHABILITATION - PHYSICAL MEDICINE&REHABILITATION	1501 WATERFORD PKWY	SAINT JOHNS	MI	Active
DSH230121AU	Child	DSH	The Memorial Hospital d/b/a Memorial Healthcare	MEMORIAL HEALTHCARE PODIATRY - PODIATRY	819 N SHIAWASSEE ST	OWOSSO	MI	Active
DSH230121AV	Child	DSH	The Memorial Hospital d/b/a Memorial Healthcare	INSTITUTE FOR NEUROSCIENCE-SAGINAW - NEUROLOGY SAGINAW	4200 Fashion Square BLVD	Saginaw	MI	Active
DSH230121AW	Child	DSH	The Memorial Hospital d/b/a Memorial Healthcare	MH INFUSION SERVICES OKEMOS - MH INFUSION SERVICES OKEMOS	2525 JOLLY RD	OKEMOS	MI	Active
DSH230121AX	Child	DSH	The Memorial Hospital d/b/a Memorial Healthcare	Diabetes and Endocrinology St. Johns - Diabetes and Endocrinology St. Johns	1501 Waterford Parkway	Saint Johns	MI	Active
DSH230121AY	Child	DSH	The Memorial Hospital d/b/a Memorial Healthcare	MH-Internal Medicine King St - Internal Medicine	818 W. King St.	Owosso	MI	Active
DSH230121AZ	Child	DSH	The Memorial Hospital d/b/a Memorial Healthcare	MEMORIAL HEALTHCARE PULMONOLOGY - Pulmonology	802 W. King St	OWOSSO	MI	Active
DSH230121B	Child	DSH	The Memorial Hospital d/b/a Memorial Healthcare	Memorial Healthcare Family Medicine- Chesaning	300 S CHAPMAN ST	CHESANING	MI	Active
DSH230121BA	Child	DSH	The Memorial Hospital d/b/a Memorial Healthcare	INSTITUTE FOR NEUROSCIENCE HOWELL - Institute for Neuroscience Howell	715 BYRON RD	HOWELL	MI	Active
DSH230121BB	Child	DSH	The Memorial Hospital d/b/a Memorial Healthcare	Memorial Multispecialty St Johns- Family Medicine - Memorial Multispecialty St Johns- Family Medicine	1501 Waterford Parkway	St Johns	MI	Active
DSH230121C	Child	DSH	The Memorial Hospital d/b/a Memorial Healthcare	Memorial Healthcare Orthopedics, Sports Medicine, & Rehabilitation- St. Johns	1000 E STURGIS ST	SAINT JOHNS	MI	Active
DSH230121D	Child	DSH	The Memorial Hospital d/b/a Memorial Healthcare	Memorial Healthcare Occupational Medicine- Health Park East	100 HEALTH PARK DR	OWOSSO	MI	Active
DSH230121E	Child	DSH	The Memorial Hospital d/b/a Memorial Healthcare	Memorial Healthcare Family & Internal Medicine-Ovid	9900 W M 21	OVID	MI	Active
DSH230121F	Child	DSH	The Memorial Hospital d/b/a Memorial Healthcare	Memorial Healthcare Family Medicine Health Park West	100 HEALTH PARK DR	OWOSSO	MI	Active
DSH230121G	Child	DSH	The Memorial Hospital d/b/a Memorial Healthcare	Memorial Healthcare Orthopedics, Sports Medicine, & Rehabilitation- Owosso	113 E WILLIAMS ST	OWOSSO	MI	Terminated
DSH230121H	Child	DSH	The Memorial Hospital d/b/a Memorial Healthcare	Memorial Surgical Associates	818 W King Street, Suite 201	OWOSSO	MI	Terminated
DSH230121J	Child	DSH	The Memorial Hospital d/b/a Memorial Healthcare	Memorial Healthcare Surgical Associates	818 W KING ST	OWOSSO	MI	Active
DSH230121K	Child	DSH	The Memorial Hospital d/b/a Memorial Healthcare	Memorial Healthcare Pediatric Medicine- 2nd flr	802 W KING ST	OWOSSO	MI	Terminated
DSH230121L	Child	DSH	The Memorial Hospital d/b/a Memorial Healthcare	OWOSSO INTERNAL MEDICINE	503 E MAIN ST	OWOSSO	MI	Terminated
DSH230121M	Child	DSH	The Memorial Hospital d/b/a Memorial Healthcare	Memorial Healthcare Ear, Nose, Throat & Audiology	818 W KING ST	OWOSSO	MI	Active
DSH230121N	Child	DSH	The Memorial Hospital d/b/a Memorial Healthcare	Memorial Healthcare Urology- Main Campus- King	818 W KING ST	OWOSSO	MI	Active
DSH230121P	Child	DSH	The Memorial Hospital d/b/a Memorial Healthcare	Memorial Healthcare Pediatric Medicine- 3rd Flr	802 W KING ST	OWOSSO	MI	Active
DSH230121Q	Child	DSH	The Memorial Hospital d/b/a Memorial Healthcare	HEALTH PARTNERS FOR WOMEN	802 W KING ST STE E	OWOSSO	MI	Terminated
DSH230121R	Child	DSH	The Memorial Hospital d/b/a Memorial Healthcare	Memorial Healthcare Internal Medicine- Owosso	300 HEALTH PARK DR	OWOSSO	MI	Active
DSH230121S	Child	DSH	The Memorial Hospital d/b/a Memorial Healthcare	Memorial Healthcare Institute for Neuroscience- Owosso	819 N. Shiawassee St	OWOSSO	MI	Active
DSH230121T	Child	DSH	The Memorial Hospital d/b/a Memorial Healthcare	Memorial Healthcare Gastroenterology- Owosso	721 N SHIAWASSEE ST	OWOSSO	MI	Active
DSH230121U	Child	DSH	The Memorial Hospital d/b/a Memorial Healthcare	Memorial Healthcare Family Medicine- Corunna	239 N STATE RD	OWOSSO	MI	Active
DSH230121V	Child	DSH	The Memorial Hospital d/b/a Memorial Healthcare	Memorial Healthcare Family Medicine- King Street	818 W. King St	OWOSSO	MI	Active
DSH230121W	Child	DSH	The Memorial Hospital d/b/a Memorial Healthcare	Memorial Healthcare Family Medicine- Ovid #104	9900 W M 21	OVID	MI	Active
DSH230121X	Child	DSH	The Memorial Hospital d/b/a Memorial Healthcare	Memorial Healthcare Family Medicine- Laingsburg	317 E GRAND RIVER RD	LAINGSBURG	MI	Active
DSH230121Y	Child	DSH	The Memorial Hospital d/b/a Memorial Healthcare	Memorial Chesaning Family Care	9000 PEET RD	CHESANING	MI	Terminated
DSH230121Z	Child	DSH	The Memorial Hospital d/b/a Memorial Healthcare	Memorial Healthcare Diabetes & Endocrinology	802 W King St	Owosso	MI	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Medicaid Billing	NPI: Number	Insert	Change Request		1558105692	9/12/2024 10:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		MI	9/12/2024 10:34 AM
Addresses	Main Address	Update	Recertification	239 N STATE RD OWOSSO, MI 48867	239 N STATE RD 101 OWOSSO, MI 48867	9/6/2024 12:46 PM
Details	Last Recertification Date	Update	Recertification	8/22/2023 5:26:05 PM	9/6/2024 12:46:11 PM	9/6/2024 12:46 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1013655414	9/25/2023 11:21 AM
Medicaid Billing	NPI: State	Insert	Change Request		MI	9/25/2023 11:21 AM
Details	Last Recertification Date	Update	Recertification	8/31/2022 11:24:59 AM	8/22/2023 5:26:05 PM	8/22/2023 5:26 PM
Contacts	Primary Contact	Update	PC Change Request	Munroe, Joseph Director of Pharmacy Memorial Healthcare 8102650858	Luna, Tessa 340B Coordinator Memorial Healthcare 9897212349	4/17/2023 10:53 AM
Contacts	Primary Contact	Update	Group Change Request	McCartney, Hanna 340B Program Manager Memorial Healthcare 9897294373	Munroe, Joseph Director of Pharmacy Memorial Healthcare 8102650858	10/18/2022 9:20 AM
Details	Last Recertification Date	Update	Recertification	9/9/2021 8:03:02 AM	8/31/2022 11:24:59 AM	8/31/2022 11:24 AM
Contacts	Authorizing Official	Update	Change Request	Koppenhaver, Colleen Chief Financial Officer Memorial Healthcare 9897294824	Tremain, Jorri Chief Financial Officer Memorial Healthcare 9897294466	4/7/2022 8:48 AM
Contacts	Primary Contact	Update	Recertification	Pardee, Kelli 340B Program Manager Memorial Healthcare 9897294373	McCartney, Hanna 340B Program Manager Memorial Healthcare 9897294373	9/9/2021 8:03 AM
Details	Last Recertification Date	Update	Recertification	9/10/2020 4:32:00 PM	9/9/2021 8:03:02 AM	9/9/2021 8:03 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1063414233 ( )		9/10/2020 4:32 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1093198624 ( )		9/10/2020 4:32 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1316008006 ( )		9/10/2020 4:32 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1386101566 ( )		9/10/2020 4:32 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1063414233	9/10/2020 4:32 PM
Medicaid Billing	NPI: State	Insert	Recertification		MI	9/10/2020 4:32 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1093198624	9/10/2020 4:32 PM
Medicaid Billing	NPI: State	Insert	Recertification		MI	9/10/2020 4:32 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1316008006	9/10/2020 4:32 PM
Medicaid Billing	NPI: State	Insert	Recertification		MI	9/10/2020 4:32 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1386101566	9/10/2020 4:32 PM
Medicaid Billing	NPI: State	Insert	Recertification		MI	9/10/2020 4:32 PM
Details	Last Recertification Date	Update	Recertification	9/11/2019 1:34:32 PM	9/10/2020 4:32:00 PM	9/10/2020 4:32 PM
Details	Entity Subname	Update	Recertification	SHIAWASSEE FAMILY MEDICINE	Memorial Healthcare Family Medicine- Corunna	9/10/2020 4:32 PM
Contacts	Primary Contact	Update	Change Request	Linder, Elizabeth Ambulatory Care Pharmacy Manager Memorial Healthcare 9897294793	Pardee, Kelli 340B Program Manager Memorial Healthcare 9897294373	11/14/2019 4:54 PM
Addresses	Main Address	Update	Recertification	239 N STATE RD SHIAWASSEE FAMILY MEDICINE OWOSSO, MI 48867-9075	239 N STATE RD OWOSSO, MI 48867	9/11/2019 1:34 PM
Medicaid Billing	Medicaid: Number	Update	Recertification	301557687	1557687	9/11/2019 1:34 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2019 1:34 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		5171252	9/11/2019 1:34 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		MI	9/11/2019 1:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1386101566	9/11/2019 1:34 PM
Details	Last Recertification Date	Update	Recertification	8/23/2018 11:19:36 AM	9/11/2019 1:34:32 PM	9/11/2019 1:34 PM
Contacts	Primary Contact	Update	Change Request	Ekola, Marla M Director of Pharmacy Memorial Healthcare 9897294588	Linder, Elizabeth Ambulatory Care Pharmacy Manager Memorial Healthcare 9897294793	6/21/2019 11:50 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/7/2019 2:50 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		301557687	3/7/2019 2:50 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MI	3/7/2019 2:50 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1063414233	3/7/2019 2:50 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1093198624	3/7/2019 2:50 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1316008006	3/7/2019 2:50 PM
Contacts	Primary Contact	Update	Recertification	Brown, Rose Interim Director of Finance Memorial Healthcare 9897294717	Ekola, Marla M Director of Pharmacy Memorial Healthcare 9897294588	8/23/2018 11:19 AM
Details	Last Recertification Date	Update	Recertification	11/7/2017 12:45:49 PM	8/23/2018 11:19:36 AM	8/23/2018 11:19 AM
Details	Entity Name	Update	Change Request	MEMORIAL HEALTHCARE	The Memorial Hospital d/b/a Memorial Healthcare	4/16/2018 2:03 PM
Details	Last Recertification Date	Update	Recertification	8/12/2016 12:00:00 AM	11/7/2017 12:45:49 PM	11/7/2017 12:45 PM
Contacts	Primary Contact	Update	Profile Change Request	Brown, Rose Director of Finance Memorial Healthcare 9897294838	Brown, Rose Interim Director of Finance Memorial Healthcare 9897294717	10/13/2017 6:33 PM
Contacts	Primary Contact	Update		Brown, Rose Director of Finance 9897294838	Brown, Rose Director of Finance Memorial Healthcare 9897294838	10/13/2017 6:31 PM
Contacts	Authorizing Official	Update		Koppenhaver, Colleen Chief Financial Officer 9897294824	Koppenhaver, Colleen Chief Financial Officer Memorial Healthcare 9897294824	10/12/2017 3:27 PM
Contacts	Authorizing Official	Insert			Koppenhaver, Colleen Chief Financial Officer 9897294824	6/29/2017 8:01 AM
Contacts	Primary Contact	Update		Elston, David E. Director of Finance 9897294838	Brown, Rose Director of Finance 9897294838	5/11/2017 3:21 PM
Contacts	Signed By	Insert			Susterich, Tim Chief Operating Officer and Chief Financial Officer 9897254824	5/11/2017 3:21 PM
Addresses	Main Address	Insert			239 N STATE RD SHIAWASSEE FAMILY MEDICINE OWOSSO, MI 48867-9075	5/11/2017 3:21 PM
Contacts	Primary Contact	Insert			Elston, David E. Director of Finance 9897294838	1/6/2017 2:25 PM
Details	Last Recertification Date	Update			8/12/2016 12:00:00 AM	8/12/2016 12:09 PM
Dates	Participating Approval Date	Update			4/26/2016 12:00:00 AM	4/26/2016 12:10 PM
Details	State	Update		Pending	Active	4/26/2016 12:10 PM
Dates	Start Date	Update			7/1/2016 12:00:00 AM	4/26/2016 12:10 PM
Details	340B ID	Update		DSH23012U	DSH230121U	4/22/2016 7:50 AM
Details	Entity Subname	Update		MEMORIAL HOSPITAL	SHIAWASSEE FAMILY MEDICINE	4/21/2016 12:20 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_60150	DSH23012U	4/21/2016 12:05 PM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_60150	4/13/2016 5:37 PM
Details	Last Recertification Date	Insert				4/13/2016 5:37 PM
Details	Grant Number	Insert				4/13/2016 5:37 PM
Details	340B ID	Insert				4/13/2016 5:37 PM
Details	Is Authorizing Official EHB Data	Insert				4/13/2016 5:37 PM
Dates	Last Date That 340B Drugs Purchased	Insert				4/13/2016 5:37 PM
Details	Medicare Provider Number	Insert			230121	4/13/2016 5:37 PM
Details	Entity Name	Insert			MEMORIAL HEALTHCARE	4/13/2016 5:37 PM
Details	Program Code	Insert			DSH	4/13/2016 5:37 PM
Details	Entity Subname	Insert			MEMORIAL HOSPITAL	4/13/2016 5:37 PM
Dates	Participating Approval Date	Insert				4/13/2016 5:37 PM
Details	State	Insert			Pending	4/13/2016 5:37 PM
Dates	Registration Date	Insert			4/13/2016 12:00:00 AM	4/13/2016 5:37 PM
Dates	Signed By Date	Insert			4/13/2016 12:00:00 AM	4/13/2016 5:37 PM
Dates	Start Date	Insert				4/13/2016 5:37 PM
Terminations	Termination Comments	Insert				4/13/2016 5:37 PM
Terminations	Termination Date	Insert				4/13/2016 5:37 PM
Terminations	Termination Effective Date	Insert				4/13/2016 5:37 PM
Terminations	Termination Reason	Insert				4/13/2016 5:37 PM