Covered Entity Details

DSH230072AH HOLLAND HOSPITAL (Active) - information as of 5/19/2025 12:52:20 AM

Main Details

Name

HOLLAND HOSPITAL

Subdivision Name

Rheumatology

Type

Disproportionate Share Hospital

Rural

340B ID

DSH230072AH

Medicare Provider Number

230072

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

7/5/2016

Participating Start Date

10/1/2016

Participating Approval Date

8/23/2016

Last Recertification Date

9/4/2024

Contacts

Authorizing Official

Holland Hospital
Mark Pawlak, President
(616) 392-5141

Primary Contact

Holland Hospital
Zachary C Tamminga, Director Finance Administration
(616) 395-4472

Addresses

Street Address

844 Washington Ave
STE 1200
Holland, MI 49423

Billing Address

Rheumatology
Dept 77557
Detroit, MI 48277-0557

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		1871672618

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
DSH230072A	Child	DSH	HOLLAND HOSPITAL	Douglas Outpatient Rehab Lab Services	2993 Blue Star Highway	Douglas	MI	Terminated
DSH230072AA	Child	DSH	HOLLAND HOSPITAL	HMIC - Ultrasound Services	3299 N Wellness Drive, Suite 120	Holland	MI	Active
DSH230072AB	Child	DSH	HOLLAND HOSPITAL	HMIC - Echovascular Services	3299 N Wellness Drive, Suite 120	Holland	MI	Active
DSH230072AC	Child	DSH	HOLLAND HOSPITAL	LMC Rehab Services	3299 N Wellness Drive, Suite 210	Holland	MI	Active
DSH230072AD	Child	DSH	HOLLAND HOSPITAL	Breast Imaging	844 S. Washington, Suite 2100	Holland	MI	Active
DSH230072AE	Child	DSH	HOLLAND HOSPITAL	Laboratory Services - Zeeland	8300 Westpark Way	Zeeland	MI	Active
DSH230072AF	Child	DSH	HOLLAND HOSPITAL	Holland Hospital Sleep Center	854 S Washington St	Holland	MI	Active
DSH230072AG	Child	DSH	HOLLAND HOSPITAL	Urgent Care - HHMB	8300 Westpark Way	Zeeland	MI	Terminated
DSH230072AH	Child	DSH	HOLLAND HOSPITAL	Rheumatology	844 Washington Ave	Holland	MI	Active
DSH230072AJ	Child	DSH	HOLLAND HOSPITAL	HH Behavioral Health OP	854 S Washington	Holland	MI	Active
DSH230072AK	Child	DSH	HOLLAND HOSPITAL	Women's Specialty Care	844 Washington Ave	Holland	MI	Active
DSH230072AL	Child	DSH	HOLLAND HOSPITAL	HH High Risk Breast	844 S Washington	Holland	MI	Active
DSH230072AM	Child	DSH	HOLLAND HOSPITAL	HH Primary Care - Saugatuck	6490 Blue Star Highway	Saugatuck	MI	Active
DSH230072AN	Child	DSH	HOLLAND HOSPITAL	Family Medicine - Zeeland	8300 Westpark Way	Zeeland	MI	Active
DSH230072AP	Child	DSH	HOLLAND HOSPITAL	LHP-Osteo	8300 Westpark Way	Zeeland	MI	Terminated
DSH230072AQ	Child	DSH	HOLLAND HOSPITAL	Family Medicine - South Washington	904 S Washington	Holland	MI	Active
DSH230072AR	Child	DSH	HOLLAND HOSPITAL	Neurology	844 Washington Ave	Holland	MI	Active
DSH230072AS	Child	DSH	HOLLAND HOSPITAL	LHP-Rheumatology	577 Michigan Ave	Holland	MI	Terminated
DSH230072AT	Child	DSH	HOLLAND HOSPITAL	Ear, Nose, Throat & Allergy	577 Michigan Ave	Holland	MI	Active
DSH230072AU	Child	DSH	HOLLAND HOSPITAL	Pediatrics & Internal Medicine	3235 N Wellness Drive	Holland	MI	Terminated
DSH230072AV	Child	DSH	HOLLAND HOSPITAL	Bone and Joint Center	3299 N Wellness Drive	Holland	MI	Active
DSH230072AW	Child	DSH	HOLLAND HOSPITAL	Foot & Ankle	3299 N Wellness Drive	Holland	MI	Terminated
DSH230072AX	Child	DSH	HOLLAND HOSPITAL	Internal Medicine - North	3235 N Wellness Drive	Holland	MI	Active
DSH230072AY	Child	DSH	HOLLAND HOSPITAL	Specialty Suite	577 Michigan Ave	Holland	MI	Terminated
DSH230072AZ	Child	DSH	HOLLAND HOSPITAL	Specialty Suite-General Surgery Procedures	577 Michigan Ave	Holland	MI	Terminated
DSH230072B	Child	DSH	HOLLAND HOSPITAL	Evergreen Commons Outpatient Rehab Services	480 State Street	Holland	MI	Active
DSH230072BA	Child	DSH	HOLLAND HOSPITAL	LHP-Women's Health Douglas	415 Wiley Road	Douglas	MI	Terminated
DSH230072BB	Child	DSH	HOLLAND HOSPITAL	Specialty Suite - WMURO	577 Michigan Ave	Holland	MI	Terminated
DSH230072BC	Child	DSH	HOLLAND HOSPITAL	Western Michigan Urological Associates	577 Michigan Ave	Holland	MI	Active
DSH230072BD	Child	DSH	HOLLAND HOSPITAL	General Surgery	577 Michigan Ave	Holland	MI	Active
DSH230072BE	Child	DSH	HOLLAND HOSPITAL	Lifestyle Medicine	175 S Waverly	Holland	MI	Active
DSH230072BF	Child	DSH	HOLLAND HOSPITAL	Pain Management	3299 Wellness Drive	Holland	MI	Active
DSH230072BG	Child	DSH	HOLLAND HOSPITAL	AUDIOLOGY - Audiology	577 MICHIGAN AVE	HOLLAND	MI	Active
DSH230072BH	Child	DSH	HOLLAND HOSPITAL	Bone Health	844 Washington Ave	Holland	MI	Active
DSH230072BJ	Child	DSH	HOLLAND HOSPITAL	Internal Medicine - Zeeland	8300 Westpark Way	Zeeland	MI	Active
DSH230072BK	Child	DSH	HOLLAND HOSPITAL	Pulmonary and Sleep Medicine	854 Washington Ave	Holland	MI	Active
DSH230072BL	Child	DSH	HOLLAND HOSPITAL	Walk In Care	8300 Westpark Way	Zeeland	MI	Active
DSH230072BM	Child	DSH	HOLLAND HOSPITAL	AUDIOLOGY ZEELAND - Audiology Zeeland	8300 WESTPARK WAY	ZEELAND	MI	Active
DSH230072BN	Child	DSH	HOLLAND HOSPITAL	Ear, Nose, Throat & Allergy - Zeeland	8300 WESTPARK WAY	ZEELAND	MI	Active
DSH230072BP	Child	DSH	HOLLAND HOSPITAL	Urology - Grand Haven Beacon	1600 S Beacon Blvd	Grand Haven	MI	Active
DSH230072BQ	Child	DSH	HOLLAND HOSPITAL	Gastroenterology	577 Michigan Ave	Holland	MI	Active
DSH230072BR	Child	DSH	HOLLAND HOSPITAL	Neurology - Grand Haven Beacon	1600 S Beacon BLVD	Grand Haven	MI	Active
DSH230072BS	Child	DSH	HOLLAND HOSPITAL	Endocrinology - Endocrinology	3235 N Wellness Dr	Holland	MI	Terminated
DSH230072BT	Child	DSH	HOLLAND HOSPITAL	Endocrinology	3235 N Wellness Dr	Holland	MI	Terminated
DSH230072BU	Child	DSH	HOLLAND HOSPITAL	Primary Care - Grand Haven	1600 S Beacon Blvd	Grand Haven	MI	Active
DSH230072BV	Child	DSH	HOLLAND HOSPITAL	West Michigan Urology - Zeeland	8300 Westpark Way	Zeeland	MI	Active
DSH230072BW	Child	DSH	HOLLAND HOSPITAL	Rheumatology Grand Haven - Rheumatology	1600 S Beacon Blvd	Grand Haven	MI	Active
DSH230072BX	Child	DSH	HOLLAND HOSPITAL	Rheumatology - Zeeland	8300 Westpark Way	Zeeland	MI	Active
DSH230072BY	Child	DSH	HOLLAND HOSPITAL	Laboratory Services - Grand Haven Beacon	1600 S Beacon Blvd	Grand Haven	MI	Active
DSH230072C	Child	DSH	HOLLAND HOSPITAL	Outpatient Cardiac/Pulmonary Rehab	602 Michigan Avenue	Holland	MI	Active
DSH230072D	Child	DSH	HOLLAND HOSPITAL	South Washington Outpatient Rehab Services	844 S. Washington Avenue	Holland	MI	Active
DSH230072E	Child	DSH	HOLLAND HOSPITAL	Urgent Care - LMC	3232 N. Wellness Drive	Holland	MI	Active
DSH230072F	Child	DSH	HOLLAND HOSPITAL	Northside Rehab Services	370 N. 120th Avenue	Holland	MI	Active
DSH230072G	Child	DSH	HOLLAND HOSPITAL	Aquatic Center Rehab Services	550 Maple Avenue	Holland	MI	Terminated
DSH230072H	Child	DSH	HOLLAND HOSPITAL	Lab Services Lakewood Fam Med	382 N. 120th	Holland	MI	Active
DSH230072J	Child	DSH	HOLLAND HOSPITAL	Outpatient Lab Services	854 S. Washington	Holland	MI	Active
DSH230072K	Child	DSH	HOLLAND HOSPITAL	Home Health Services	750 E 40th St	Holland	MI	Active
DSH230072N	Child	DSH	HOLLAND HOSPITAL	Holland Hospital Imaging & Laboratory Services	8300 Westpark Way	Zeeland	MI	Terminated
DSH230072P	Child	DSH	HOLLAND HOSPITAL	Holland Hospital Surgery Center	12087 Felch Street	Holland	MI	Active
DSH230072Q	Child	DSH	HOLLAND HOSPITAL	Laboratory Services - Saugatuck	6490 Blue Star Highway	Saugatuck	MI	Active
DSH230072R	Child	DSH	HOLLAND HOSPITAL	Rehab Services - Saugatuck	6490 Blue Star Highway	Saugatuck	MI	Active
DSH230072S	Child	DSH	HOLLAND HOSPITAL	HH Radiology Services	8300 Westpark Way	Zeeland	MI	Active
DSH230072T	Child	DSH	HOLLAND HOSPITAL	HH PET CT Services	8300 Westpark Way	Zeeland	MI	Active
DSH230072U	Child	DSH	HOLLAND HOSPITAL	HH Mammography Services	8300 Westpark Way	Zeeland	MI	Active
DSH230072V	Child	DSH	HOLLAND HOSPITAL	HH Mobile MRI	8300 Westpark Way	Zeeland	MI	Active
DSH230072W	Child	DSH	HOLLAND HOSPITAL	LMC Lab Services	3235 N Wellness Drive, Suite 250	Holland	MI	Active
DSH230072X	Child	DSH	HOLLAND HOSPITAL	HMIC - CT Services	3299 N Wellness Drive, Suite 120	Holland	MI	Active
DSH230072Y	Child	DSH	HOLLAND HOSPITAL	HMIC - Mammography	3299 N Wellness Drive, Suite 120	Holland	MI	Active
DSH230072Z	Child	DSH	HOLLAND HOSPITAL	HMIC - Radiology Services	3299 N Wellness Drive, Suite 120	Holland	MI	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Group Change Request	Fletcher, Carol Sr. Director Revenue Integrity Holland Hospital 6163943227	Tamminga, Zachary C Director Finance Administration Holland Hospital 6163954472	12/2/2024 2:48 PM
Details	Last Recertification Date	Update	Recertification	9/5/2023 1:21:43 PM	9/4/2024 8:47:01 AM	9/4/2024 8:47 AM
Contacts	Authorizing Official	Update	Profile Change Request	Pawlak, Mark Executive Vice President Holland Hospital 6163925141	Pawlak, Mark President Holland Hospital 6163925141	3/12/2024 1:52 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1871672618	3/12/2024 12:54 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	3/12/2024 12:54 PM
Details	Last Recertification Date	Update	Recertification	9/8/2022 3:57:11 PM	9/5/2023 1:21:43 PM	9/5/2023 1:21 PM
Contacts	Authorizing Official	Update	Profile Change Request	Pawlak, Mark SR. Vice President, Operations Holland Hospital 6163925141	Pawlak, Mark Executive Vice President Holland Hospital 6163925141	7/10/2023 12:56 PM
Addresses	Main Address	Update	Change Request	577 Michigan Ave Suite 104 Holland, MI 49423	844 Washington Ave STE 1200 Holland, MI 49423	7/10/2023 7:20 AM
Details	Last Recertification Date	Update	Recertification	9/9/2021 9:06:36 AM	9/8/2022 3:57:11 PM	9/8/2022 3:57 PM
Details	Last Recertification Date	Update	Recertification	9/11/2020 11:11:56 AM	9/9/2021 9:06:36 AM	9/9/2021 9:06 AM
Contacts	Authorizing Official	Update	Change Request	STEELE, TERRY L. CFO Holland Hospital 6163925141	Pawlak, Mark SR. Vice President, Operations Holland Hospital 6163925141	4/20/2021 10:07 AM
Contacts	Primary Contact	Update	Profile Change Request	Fletcher, Carol Director Revenue Integrity Holland Hospital 6163943227	Fletcher, Carol Sr. Director Revenue Integrity Holland Hospital 6163943227	4/12/2021 11:00 AM
Addresses	Billing Address	Update	Change Request	Specialty Suite-Rheumatology Dept 77635 PO Box 77000 Detroit, MI 48277-0635	Rheumatology Dept 77557 Detroit, MI 48277-0557	10/28/2020 8:30 AM
Details	Entity Subname	Update	Change Request	Specialty Suite-Rheumatology	Rheumatology	10/28/2020 8:30 AM
Details	Last Recertification Date	Update	Recertification	9/11/2019 2:38:13 PM	9/11/2020 11:11:56 AM	9/11/2020 11:11 AM
Details	Last Recertification Date	Update	Recertification	8/24/2018 8:08:18 AM	9/11/2019 2:38:13 PM	9/11/2019 2:38 PM
Details	Last Recertification Date	Update	Recertification	11/8/2017 1:49:06 PM	8/24/2018 8:08:18 AM	8/24/2018 8:08 AM
Details	Last Recertification Date	Update	Recertification	10/25/2017 4:47:39 PM	11/8/2017 1:49:06 PM	11/8/2017 1:49 PM
Details	Last Recertification Date	Update	Recertification		10/25/2017 4:47:39 PM	10/25/2017 4:47 PM
Contacts	Authorizing Official	Update		STEELE, TERRY L. CFO 6163925141	STEELE, TERRY L. CFO Holland Hospital 6163925141	10/3/2017 2:32 PM
Contacts	Signed By	Update		STEELE, TERRY L. CFO 6163925141	STEELE, TERRY L. CFO Holland Hospital 6163925141	10/3/2017 2:32 PM
Contacts	Primary Contact	Update		Fletcher, Carol Director Revenue Integrity 6163943227	Fletcher, Carol Director Revenue Integrity Holland Hospital 6163943227	10/2/2017 1:47 PM
Addresses	Main Address	Insert			577 Michigan Ave Suite 104 Holland, MI 49423	8/24/2016 1:45 PM
Addresses	Billing Address	Insert			Specialty Suite-Rheumatology Dept 77635 PO Box 77000 Detroit, MI 48277-0635	8/24/2016 1:45 PM
Contacts	Authorizing Official	Insert			STEELE, TERRY L. CFO 6163925141	8/24/2016 1:45 PM
Contacts	Signed By	Insert			STEELE, TERRY L. CFO 6163925141	8/24/2016 1:45 PM
Contacts	Primary Contact	Insert			Fletcher, Carol Director Revenue Integrity 6163943227	8/24/2016 1:45 PM
Dates	Participating Approval Date	Update			8/23/2016 12:00:00 AM	8/23/2016 5:47 PM
Details	State	Update		Pending	Active	8/23/2016 5:47 PM
Dates	Start Date	Update			10/1/2016 12:00:00 AM	8/23/2016 5:47 PM
Details	Entity Subname	Update		Specialty Suite-Rheumatology / Specialty Suite-Rheumatology	Specialty Suite-Rheumatology	8/23/2016 10:33 AM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_70971	DSH230072AH	8/12/2016 1:58 PM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_70971	7/5/2016 4:24 PM
Details	Last Recertification Date	Insert				7/5/2016 4:24 PM
Details	Grant Number	Insert				7/5/2016 4:24 PM
Details	340B ID	Insert				7/5/2016 4:24 PM
Details	Is Authorizing Official EHB Data	Insert				7/5/2016 4:24 PM
Dates	Last Date That 340B Drugs Purchased	Insert				7/5/2016 4:24 PM
Details	Medicare Provider Number	Insert			230072	7/5/2016 4:24 PM
Details	Entity Name	Insert			HOLLAND HOSPITAL	7/5/2016 4:24 PM
Details	Program Code	Insert			DSH	7/5/2016 4:24 PM
Details	Entity Subname	Insert			Specialty Suite-Rheumatology / Specialty Suite-Rheumatology	7/5/2016 4:24 PM
Dates	Participating Approval Date	Insert				7/5/2016 4:24 PM
Details	State	Insert			Pending	7/5/2016 4:24 PM
Dates	Registration Date	Insert			7/5/2016 12:00:00 AM	7/5/2016 4:24 PM
Dates	Signed By Date	Insert			7/5/2016 12:00:00 AM	7/5/2016 4:24 PM
Dates	Start Date	Insert				7/5/2016 4:24 PM
Terminations	Termination Comments	Insert				7/5/2016 4:24 PM
Terminations	Termination Date	Insert				7/5/2016 4:24 PM
Terminations	Termination Effective Date	Insert				7/5/2016 4:24 PM
Terminations	Termination Reason	Insert				7/5/2016 4:24 PM