Contacts | Primary Contact | Update | Group Change Request | Lee, Janine M
Clinical Pharmacist, 340B Program
University of Michigan
7349368210 | Gillespie, Cindy
Assistant Director, Pharmacy 340B Program
University of Michigan
7346155867 | 2/12/2025 11:07 AM |
Contacts | Authorizing Official | Update | Change Request | Miller, David
President University of Michigan Health Systems
University of Michigan Hospitals and Health Centers
7346476313 | Habers, Dana
Chief Operating Officer, Pharmacy
University of Michigan
7349364338 | 12/17/2024 12:10 PM |
Contacts | Primary Contact | Update | Profile Change Request | Lee, Janine M
Assistant Direct 340B Program
University of Michigan
7349368210 | Lee, Janine M
Clinical Pharmacist, 340B Program
University of Michigan
7349368210 | 8/22/2024 9:55 AM |
Details | Last Recertification Date | Update | Recertification | 8/14/2023 9:23:12 AM | 8/21/2024 11:22:40 AM | 8/21/2024 11:22 AM |
Contacts | Primary Contact | Update | Group Change Request | Haverkamp, Peter Joseph
Director of Pharmacy Services
Metro Health Hospital
6162527216 | Lee, Janine M
Assistant Direct 340B Program
University of Michigan
7349368210 | 7/23/2024 3:48 PM |
Contacts | Authorizing Official | Update | Change Request | Kurtz, Kris
CFO
Metro Health Hospital
6162524844 | Miller, David
President University of Michigan Health Systems
University of Michigan Hospitals and Health Centers
7346476313 | 3/6/2024 9:55 AM |
Details | Last Recertification Date | Update | Recertification | 8/24/2022 9:20:25 AM | 8/14/2023 9:23:12 AM | 8/14/2023 9:23 AM |
Details | Last Recertification Date | Update | Recertification | 9/10/2021 9:14:11 AM | 8/24/2022 9:20:25 AM | 8/24/2022 9:20 AM |
Details | Last Recertification Date | Update | Recertification | 9/10/2020 1:31:12 PM | 9/10/2021 9:14:11 AM | 9/10/2021 9:14 AM |
Details | Last Recertification Date | Update | Recertification | 8/22/2019 11:31:54 AM | 9/10/2020 1:31:12 PM | 9/10/2020 1:31 PM |
Addresses | Main Address | Update | Change Request |
4055 CASCADE RD SE SUITE 200
METRO HEALTH PARK EAST OUTPATIENT SURGERY CENTER
GRAND RAPIDS, MI 49546-2149 |
4055 CASCADE RD SE
METRO HEALTH PARK EAST OUTPATIENT SURGERY CENTER
GRAND RAPIDS, MI 49546 | 2/20/2020 10:22 AM |
Details | Last Recertification Date | Update | Recertification | 9/10/2018 1:11:25 PM | 8/22/2019 11:31:54 AM | 8/22/2019 11:31 AM |
Details | Last Recertification Date | Update | Recertification | 11/21/2017 11:42:42 AM | 9/10/2018 1:11:25 PM | 9/10/2018 1:11 PM |
Addresses | Shipping Address | Insert | Change Request | | Metro Health Park East Pharmacy
4055 Cascade Road SE
Suite 104
Grand Rapids, MI 49546-0000 | 4/17/2018 7:18 AM |
Contacts | Authorizing Official | Update | Change Request | FAAS, MICHAEL D.
CEO
Metropolitan Hospital
6162524788 | Kurtz, Kris
CFO
Metro Health Hospital
6162524844 | 4/11/2018 9:09 AM |
Details | Last Recertification Date | Update | Recertification | | 11/21/2017 11:42:42 AM | 11/21/2017 11:42 AM |
Contacts | Authorizing Official | Update | | FAAS, MICHAEL D.
CEO
6162524788 | FAAS, MICHAEL D.
CEO
Metropolitan Hospital
6162524788 | 11/7/2017 2:35 PM |
Contacts | Signed By | Update | | FAAS, MICHAEL D.
CEO
6162524788 | FAAS, MICHAEL D.
CEO
Metropolitan Hospital
6162524788 | 11/7/2017 2:35 PM |
Contacts | Primary Contact | Update | | Haverkamp, Peter
Director of Pharmacy Services
6162527216 | Haverkamp, Peter Joseph
Director of Pharmacy Services
Metro Health Hospital
6162527216 | 10/18/2017 1:08 PM |
Contacts | Authorizing Official | Insert | | | FAAS, MICHAEL D.
CEO
6162524788 | 7/11/2017 1:45 PM |
Contacts | Signed By | Insert | | | FAAS, MICHAEL D.
CEO
6162524788 | 7/11/2017 1:45 PM |
Contacts | Primary Contact | Insert | | | Haverkamp, Peter
Director of Pharmacy Services
6162527216 | 3/11/2017 11:22 AM |
Addresses | Main Address | Insert | | |
4055 CASCADE RD SE SUITE 200
METRO HEALTH PARK EAST OUTPATIENT SURGERY CENTER
GRAND RAPIDS, MI 49546-2149 | 3/11/2017 11:22 AM |
Addresses | Billing Address | Insert | | | Metro Health Accounts Payable
PO Box 911
Wyoming, MI 49519-0911 | 3/11/2017 11:22 AM |
Dates | Participating Approval Date | Update | | | 3/11/2017 12:00:00 AM | 3/11/2017 11:22 AM |
Details | State | Update | | Pending | Active | 3/11/2017 11:22 AM |
Dates | Start Date | Update | | | 4/1/2017 12:00:00 AM | 3/11/2017 11:22 AM |
Details | 340B ID | Update | | OUTPATIENT_ONLINE_REG_75034 | DSH230236X | 2/10/2017 2:39 PM |
Details | Entity Subname | Update | | METROPOLITAN HOSPITAL / Metro Health Park East Outpatient Surgery Center | Metro Health Park East / Outpatient Surgery Center | 2/10/2017 2:39 PM |
Details | 340B ID | Update | | | OUTPATIENT_ONLINE_REG_75034 | 1/16/2017 11:19 AM |
Details | Last Recertification Date | Insert | | | | 1/16/2017 11:19 AM |
Details | Grant Number | Insert | | | | 1/16/2017 11:19 AM |
Details | 340B ID | Insert | | | | 1/16/2017 11:19 AM |
Details | Is Authorizing Official EHB Data | Insert | | | | 1/16/2017 11:19 AM |
Dates | Last Date That 340B Drugs Purchased | Insert | | | | 1/16/2017 11:19 AM |
Details | Medicare Provider Number | Insert | | | 230236 | 1/16/2017 11:19 AM |
Details | Entity Name | Insert | | | METROPOLITAN HOSPITAL | 1/16/2017 11:19 AM |
Details | Program Code | Insert | | | DSH | 1/16/2017 11:19 AM |
Details | Entity Subname | Insert | | | METROPOLITAN HOSPITAL / Metro Health Park East Outpatient Surgery Center | 1/16/2017 11:19 AM |
Dates | Participating Approval Date | Insert | | | | 1/16/2017 11:19 AM |
Details | State | Insert | | | Pending | 1/16/2017 11:19 AM |
Dates | Registration Date | Insert | | | 1/16/2017 12:00:00 AM | 1/16/2017 11:19 AM |
Dates | Signed By Date | Insert | | | 1/16/2017 12:00:00 AM | 1/16/2017 11:19 AM |
Dates | Start Date | Insert | | | | 1/16/2017 11:19 AM |
Terminations | Termination Comments | Insert | | | | 1/16/2017 11:19 AM |
Terminations | Termination Date | Insert | | | | 1/16/2017 11:19 AM |
Terminations | Termination Effective Date | Insert | | | | 1/16/2017 11:19 AM |
Terminations | Termination Reason | Insert | | | | 1/16/2017 11:19 AM |