Covered Entity Details

DSH230070Q COVENANT MEDICAL CENTER (Active) - information as of 6/21/2025 12:02:41 AM

Main Details

Name

COVENANT MEDICAL CENTER

Subdivision Name

COVENANT RADIOLOGY - NUCLEAR MEDICINE

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH230070Q

Medicare Provider Number

230070

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

7/12/2017

Participating Start Date

10/1/2017

Participating Approval Date

7/24/2017

Last Recertification Date

8/13/2024

Contacts

Authorizing Official

Covenant Medical Center
KEVIN S. ALBOSTA, CFO
(989) 583-2769

Primary Contact

Covenant Medical Center
Aaron Feinauer, Director of Pharmacy
(989) 583-4788

Addresses

Street Address

700 COOPER AVE
SAGINAW, MI 48602

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		1588656946,1619412376

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
DSH230070A	Child	DSH	COVENANT MEDICAL CENTER	COVENANT HEALTHCARE - ANESTHESIA	700 COOPER AVE	SAGINAW	MI	Active
DSH230070AA	Child	DSH	COVENANT MEDICAL CENTER	OCCUPATIONAL THERAPY - BAY CITY OT	2919 WILDER RD	BAY CITY	MI	Active
DSH230070AB	Child	DSH	COVENANT MEDICAL CENTER	OCCUPATIONAL THERAPY - MACKINAW OT	5400 MACKINAW RD	SAGINAW	MI	Active
DSH230070AC	Child	DSH	COVENANT MEDICAL CENTER	OCCUPATIONAL THERAPY - NEURO OT COOPER	700 COOPER AVE	SAGINAW	MI	Active
DSH230070AD	Child	DSH	COVENANT MEDICAL CENTER	OCCUPATIONAL THERAPY - ORTHO OT COOPER	700 COOPER AVE	SAGINAW	MI	Active
DSH230070AE	Child	DSH	COVENANT MEDICAL CENTER	OCCUPATIONAL THERAPY - OT FRANKENMUTH	600 N MAIN ST	FRANKENMUTH	MI	Active
DSH230070AF	Child	DSH	COVENANT MEDICAL CENTER	PHYSICAL THERAPY - BAY CITY PT	2919 WILDER RD	BAY CITY	MI	Active
DSH230070AG	Child	DSH	COVENANT MEDICAL CENTER	PHYSICAL THERAPY - HEMLOCK PT	16440 GRATIOT RD	HEMLOCK	MI	Active
DSH230070AH	Child	DSH	COVENANT MEDICAL CENTER	PHYSICAL THERAPY - MACKINAW PT	5400 MACKINAW RD	SAGINAW	MI	Active
DSH230070AJ	Child	DSH	COVENANT MEDICAL CENTER	PHYSICAL THERAPY - NEURO PT COOPER	700 COOPER AVE	SAGINAW	MI	Active
DSH230070AK	Child	DSH	COVENANT MEDICAL CENTER	PHYSICAL THERAPY - ORTHO PT COOPER	700 COOPER AVE	SAGINAW	MI	Active
DSH230070AL	Child	DSH	COVENANT MEDICAL CENTER	PHYSICAL THERAPY - PT FRANKENMUTH	600 N MAIN ST	FRANKENMUTH	MI	Active
DSH230070AM	Child	DSH	COVENANT MEDICAL CENTER	PHYSICAL THERAPY - PT GRATIOT	5483 GRATIOT RD	SAGINAW	MI	Active
DSH230070AN	Child	DSH	COVENANT MEDICAL CENTER	SPEECH PATHOLOGY - OUTPATIENT SPEECH THERAPY	700 COOPER AVE	SAGINAW	MI	Active
DSH230070AP	Child	DSH	COVENANT MEDICAL CENTER	LABORATORY - BAY CITY CAMPUS	2919 WILDER RD	BAY CITY	MI	Active
DSH230070AQ	Child	DSH	COVENANT MEDICAL CENTER	LABORATORY - GRATIOT CAMPUS	16440 GRATIOT RD	HEMLOCK	MI	Active
DSH230070AR	Child	DSH	COVENANT MEDICAL CENTER	LABORATORY - STATE STREET CAMPUS	5570 STATE ST	SAGINAW	MI	Active
DSH230070AS	Child	DSH	COVENANT MEDICAL CENTER	LABORATORY - FRANKENMUTH CAMPUS	600 N MAIN ST	FRANKENMUTH	MI	Active
DSH230070AT	Child	DSH	COVENANT MEDICAL CENTER	LABORATORY - IRVING CAMPUS	600 IRVING AVE	SAGINAW	MI	Active
DSH230070AU	Child	DSH	COVENANT MEDICAL CENTER	LABORATORY - MACKINAW CAMPUS	5400 MACKINAW RD	SAGINAW	MI	Active
DSH230070AV	Child	DSH	COVENANT MEDICAL CENTER	RADIOLOGY ULTRASOUND - STATE STREET US	5570 STATE ST	SAGINAW	MI	Active
DSH230070AW	Child	DSH	COVENANT MEDICAL CENTER	NUCLEAR MEDICINE - MACKINAW CAMPUS	5400 MACKINAW RD	SAGINAW	MI	Active
DSH230070AX	Child	DSH	COVENANT MEDICAL CENTER	RADIOLOGY ULTRASOUND - MACKINAW CAMPUS	5400 MACKINAW RD	SAGINAW	MI	Active
DSH230070AY	Child	DSH	COVENANT MEDICAL CENTER	DIAGNOSTIC RADIOLOGY - MACKINAW CAMPUS	5400 MACKINAW RD	SAGINAW	MI	Active
DSH230070AZ	Child	DSH	COVENANT MEDICAL CENTER	RADIOLOGY ULTRASOUND - FRANKENMUTH	600 N MAIN ST	FRANKENMUTH	MI	Active
DSH230070B	Child	DSH	COVENANT MEDICAL CENTER	COVENANT HEALTHCARE MACKINAW	5400 MACKINAW	SAGINAW	MI	Terminated
DSH230070BA	Child	DSH	COVENANT MEDICAL CENTER	NUCLEAR MEDICINE - COOPER E NM	900 COOPER AVE	SAGINAW	MI	Active
DSH230070BB	Child	DSH	COVENANT MEDICAL CENTER	RADIOLOGY ULTRASOUND - COOPER CAMPUS	700 COOPER AVE	SAGINAW	MI	Active
DSH230070BC	Child	DSH	COVENANT MEDICAL CENTER	BREAST HEALTH DIAGNOSTICS - STATE STREET BREAST HEALTH	5570 STATE ST	SAGINAW	MI	Active
DSH230070BD	Child	DSH	COVENANT MEDICAL CENTER	BREAST HEALTH DIAGNOSTICS - FRANKENMUTH BREAST HEALTH	600 N MAIN ST	FRANKENMUTH	MI	Active
DSH230070BE	Child	DSH	COVENANT MEDICAL CENTER	DIAGNOSTIC RADIOLOGY - COOPER E DIAGNOSTIC IMAGING	900 COOPER AVE	Saginaw	MI	Active
DSH230070BF	Child	DSH	COVENANT MEDICAL CENTER	Dialysis - 48602	900 Cooper Ave	Saginaw	MI	Approved
DSH230070BG	Child	DSH	COVENANT MEDICAL CENTER	Clinic - PICC Team	700 Cooper Ave	Saginaw	MI	Approved
DSH230070E	Child	DSH	COVENANT MEDICAL CENTER	Covenant Medical Center Emergency	900 Cooper	Saginaw	MI	Active
DSH230070F	Child	DSH	COVENANT MEDICAL CENTER	CANCER CARE AND INFUSION THERAPY	5400 MACKINAW RD	SAGINAW	MI	Active
DSH230070G	Child	DSH	COVENANT MEDICAL CENTER	COVENANT 900 COOPER / ENDOSCOPY	900 COOPER AVE	SAGINAW	MI	Active
DSH230070H	Child	DSH	COVENANT MEDICAL CENTER	COVENANT 900 COOPER / CARDIAC TESTING	900 COOPER AVE	SAGINAW	MI	Active
DSH230070J	Child	DSH	COVENANT MEDICAL CENTER	COVENANT 900 COOPER / CARDIAC RECOVERY	900 COOPER AVE	SAGINAW	MI	Active
DSH230070K	Child	DSH	COVENANT MEDICAL CENTER	COVENANT 700 COOPER / CARDIAC CATH LAB/EP LAB	700 COOPER AVE	SAGINAW	MI	Active
DSH230070L	Child	DSH	COVENANT MEDICAL CENTER	COVENANT 700 COOPER AVE / INTERVENTIONAL RADIOLOGY	700 COOPER AVE	SAGINAW	MI	Active
DSH230070M	Child	DSH	COVENANT MEDICAL CENTER	COVENANT 700 COOPER / COOPER POHA/PACU/AMBU	700 COOPER AVE	SAGINAW	MI	Active
DSH230070N	Child	DSH	COVENANT MEDICAL CENTER	700 COOPER BUILDING / COOPER OR	700 COOPER AVE	SAGINAW	MI	Active
DSH230070P	Child	DSH	COVENANT MEDICAL CENTER	COVENANT 900 COOPER / CLINICAL DECISION UNIT	900 COOPER AVE	SAGINAW	MI	Active
DSH230070Q	Child	DSH	COVENANT MEDICAL CENTER	COVENANT RADIOLOGY - NUCLEAR MEDICINE	700 COOPER AVE	SAGINAW	MI	Active
DSH230070R	Child	DSH	COVENANT MEDICAL CENTER	COVENANT RESPIRATORY THERAPY	700 COOPER AVE	SAGINAW	MI	Active
DSH230070S	Child	DSH	COVENANT MEDICAL CENTER	Radiology Diagnostic - 72020 Breast Health Center	5400 Mackinaw Rd	Saginaw	MI	Active
DSH230070T	Child	DSH	COVENANT MEDICAL CENTER	Oncology - 79095 Covenant Radiation Center	4141 Tittabawassee Rd	Saginaw	MI	Active
DSH230070U	Child	DSH	COVENANT MEDICAL CENTER	CARDIAC REHAB MACKINAW - CARDIAC REHAB MACKINAW	5400 MACKINAW RD	SAGINAW	MI	Active
DSH230070V	Child	DSH	COVENANT MEDICAL CENTER	CLINIC - WOUND CARE	900 COOPER	SAGINAW	MI	Active
DSH230070W	Child	DSH	COVENANT MEDICAL CENTER	DIAGNOSTIC RADIOLOGY - BONE DENSITY	5570 STATE ST	SAGINAW	MI	Active
DSH230070X	Child	DSH	COVENANT MEDICAL CENTER	DIAGNOSTIC RADIOLOGY - PET SCAN	600 IRVING AVE	SAGINAW	MI	Active
DSH230070Y	Child	DSH	COVENANT MEDICAL CENTER	ELECTROCARDIOLOGY - NEURODIAGNOSTICS	700 COOPER AVE	SAGINAW	MI	Active
DSH230070Z	Child	DSH	COVENANT MEDICAL CENTER	MARLETTE ONCOLOGY - INFUSION AND RADIATION CENTER	2780 MAIN ST	MARLETTE	MI	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Medicaid Billing	NPI: Number	Insert	Group Change Request		1619412376	3/4/2025 9:47 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		MI	3/4/2025 9:47 AM
Contacts	Primary Contact	Update	Group Change Request	WERNETTE, TERRENCE DIRECTOR OF PHARMACY Covenant HealthCare 9895834075	Feinauer, Aaron Director of Pharmacy Covenant Medical Center 9895834788	10/15/2024 9:08 AM
Details	Last Recertification Date	Update	Recertification	8/29/2023 9:42:47 AM	8/13/2024 7:24:37 AM	8/13/2024 7:24 AM
Details	Last Recertification Date	Update	Recertification	9/7/2022 8:14:15 AM	8/29/2023 9:42:47 AM	8/29/2023 9:42 AM
Details	Last Recertification Date	Update	Recertification	8/24/2021 8:45:11 AM	9/7/2022 8:14:15 AM	9/7/2022 8:14 AM
Details	Last Recertification Date	Update	Recertification	8/25/2020 8:18:20 AM	8/24/2021 8:45:11 AM	8/24/2021 8:45 AM
Medicaid Billing	NPI: State	Update	Recertification		MI	8/25/2020 8:18 AM
Details	Last Recertification Date	Update	Recertification	9/5/2019 8:02:02 AM	8/25/2020 8:18:20 AM	8/25/2020 8:18 AM
Details	Last Recertification Date	Update	Recertification	8/21/2018 3:09:07 PM	9/5/2019 8:02:02 AM	9/5/2019 8:02 AM
Details	Last Recertification Date	Update	Recertification	12/1/2017 11:44:03 AM	8/21/2018 3:09:07 PM	8/21/2018 3:09 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1588656946	12/5/2017 9:11 AM
Details	Last Recertification Date	Update	Recertification		12/1/2017 11:44:03 AM	12/1/2017 11:44 AM
Contacts	Authorizing Official	Update		ALBOSTA, KEVIN S. CFO 9895832769	ALBOSTA, KEVIN S. CFO Covenant Medical Center 9895832769	10/24/2017 2:31 PM
Contacts	Signed By	Update		ALBOSTA, KEVIN S. CFO 9895832769	ALBOSTA, KEVIN S. CFO Covenant Medical Center 9895832769	10/24/2017 2:31 PM
Contacts	Primary Contact	Update		WERNETTE, TERRENCE DIRECTOR OF PHARMACY 9895834075	WERNETTE, TERRENCE DIRECTOR OF PHARMACY Covenant HealthCare 9895834075	10/22/2017 2:34 PM
Contacts	Authorizing Official	Insert			ALBOSTA, KEVIN S. CFO 9895832769	7/24/2017 6:14 PM
Contacts	Signed By	Insert			ALBOSTA, KEVIN S. CFO 9895832769	7/24/2017 6:14 PM
Contacts	Primary Contact	Insert			WERNETTE, TERRENCE DIRECTOR OF PHARMACY 9895834075	7/24/2017 6:14 PM
Addresses	Main Address	Insert			700 COOPER AVE SAGINAW, MI 48602	7/24/2017 6:14 PM
Details	State	Update		Approved	Active	7/24/2017 6:14 PM
Dates	Participating Approval Date	Update			7/24/2017 12:00:00 AM	7/24/2017 6:13 PM
Details	State	Update		Pending	Approved	7/24/2017 6:13 PM
Dates	Start Date	Update			10/1/2017 12:00:00 AM	7/24/2017 6:13 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_78355	DSH230070Q	7/13/2017 1:43 PM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_78355	7/12/2017 1:42 PM
Details	Last Recertification Date	Insert				7/12/2017 1:42 PM
Details	Grant Number	Insert				7/12/2017 1:42 PM
Details	340B ID	Insert				7/12/2017 1:42 PM
Details	Is Authorizing Official EHB Data	Insert				7/12/2017 1:42 PM
Dates	Last Date That 340B Drugs Purchased	Insert				7/12/2017 1:42 PM
Details	Medicare Provider Number	Insert			230070	7/12/2017 1:42 PM
Details	Entity Name	Insert			COVENANT MEDICAL CENTER	7/12/2017 1:42 PM
Details	Program Code	Insert			DSH	7/12/2017 1:42 PM
Details	Entity Subname	Insert			COVENANT RADIOLOGY - NUCLEAR MEDICINE	7/12/2017 1:42 PM
Dates	Participating Approval Date	Insert				7/12/2017 1:42 PM
Details	State	Insert			Pending	7/12/2017 1:42 PM
Dates	Registration Date	Insert			7/12/2017 12:00:00 AM	7/12/2017 1:42 PM
Dates	Signed By Date	Insert			7/12/2017 12:00:00 AM	7/12/2017 1:42 PM
Dates	Start Date	Insert				7/12/2017 1:42 PM
Terminations	Termination Comments	Insert				7/12/2017 1:42 PM
Terminations	Termination Date	Insert				7/12/2017 1:42 PM
Terminations	Termination Effective Date	Insert				7/12/2017 1:42 PM
Terminations	Termination Reason	Insert				7/12/2017 1:42 PM