| Details | State | Update | | To Be Terminated | Terminated | 1/1/2025 12:01 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | Termination Request | | 11/30/2024 12:00:00 AM | 12/17/2024 8:30 AM |
| Details | State | Update | Termination Request | Active | To Be Terminated | 12/17/2024 8:30 AM |
| Terminations | Termination Date | Update | Termination Request | | 1/1/2025 12:00:00 AM | 12/17/2024 8:30 AM |
| Terminations | Termination Effective Date | Update | Termination Request | | 11/30/2024 12:00:00 AM | 12/17/2024 8:30 AM |
| Terminations | Termination Reason | Update | Termination Request | | DSH percentage below statutory minimum | 12/17/2024 8:30 AM |
| Details | Last Recertification Date | Update | Recertification | 8/24/2023 10:01:18 AM | 8/19/2024 12:19:59 PM | 8/19/2024 12:19 PM |
| Contacts | Primary Contact | Update | Profile Change Request | Waibel, Lisa
340B Supervisor
MyMichigan Health
9897945231 | Waibel, Lisa
340B Manager
MyMichigan Health
9897945231 | 7/23/2024 3:55 PM |
| Details | Last Recertification Date | Update | Recertification | 9/6/2022 11:52:15 AM | 8/24/2023 10:01:18 AM | 8/24/2023 10:01 AM |
| Contacts | Authorizing Official | Update | Profile Change Request | Sherwin, Chuck
President
MidMichigan Medical Center - Alpena
9893567779 | Sherwin, Chuck
President
MyMichigan Medical Center Midland
9897947625 | 6/7/2023 6:50 AM |
| Contacts | Primary Contact | Update | Profile Change Request | Waibel, Lisa
340B Supervisor
MyMichigan Health
9895450567 | Waibel, Lisa
340B Supervisor
MyMichigan Health
9897945231 | 6/6/2023 2:44 PM |
| Contacts | Primary Contact | Update | Group Change Request | Bruhnsen, Kayla
340B Program Coordinator
MidMichigan Medical Center
9894885799 | Waibel, Lisa
340B Supervisor
MyMichigan Health
9895450567 | 3/29/2023 7:40 AM |
| Details | Entity Name | Update | Change Request | MIDMICHIGAN MEDICAL CTR | MYMICHIGAN MEDICAL CENTER MIDLAND | 10/19/2022 1:38 PM |
| Details | Last Recertification Date | Update | Recertification | 8/19/2021 12:09:04 PM | 9/6/2022 11:52:15 AM | 9/6/2022 11:52 AM |
| Contacts | Authorizing Official | Update | Change Request | Cross, Bryan Rex
President
MidMichigan Health
9898391322 | Sherwin, Chuck
President
MidMichigan Medical Center - Alpena
9893567779 | 7/13/2022 9:50 AM |
| Contacts | Primary Contact | Update | PC Change Request | Waibel, Lisa
340B Program Coordinator
MidMichigan Medical Center
9894885799 | Bruhnsen, Kayla
340B Program Coordinator
MidMichigan Medical Center
9894885799 | 6/21/2022 6:29 AM |
| Details | Last Recertification Date | Update | Recertification | 8/17/2020 1:16:39 PM | 8/19/2021 12:09:04 PM | 8/19/2021 12:09 PM |
| Contacts | Primary Contact | Update | Profile Change Request | Waibel, Lisa
340B Program Coordinator
MidMichigan Medical Center
9895450567 | Waibel, Lisa
340B Program Coordinator
MidMichigan Medical Center
9894885799 | 7/20/2021 12:45 PM |
| Contacts | Primary Contact | Update | Change Request | Constantine, Eileen
340B Program Coordinator
MidMichigan Medical Center - Gratiot
9894667258 | Waibel, Lisa
340B Program Coordinator
MidMichigan Medical Center
9895450567 | 3/4/2021 12:19 PM |
| Contacts | Authorizing Official | Update | Profile Change Request | Cross, Bryan Rex
Vice President
MidMichigan Health
9898391322 | Cross, Bryan Rex
President
MidMichigan Health
9898391322 | 2/22/2021 6:09 PM |
| Contacts | Signed By | Update | Profile Change Request | Cross, Bryan Rex
Vice President
MidMichigan Health
9898391322 | Cross, Bryan Rex
President
MidMichigan Health
9898391322 | 2/22/2021 6:09 PM |
| Details | Last Recertification Date | Update | Recertification | | 8/17/2020 1:16:39 PM | 8/17/2020 1:16 PM |
| Details | State | Update | | Approved | Active | 7/1/2020 12:00 AM |
| Details | State | Update | | Approved | Active | 7/1/2020 12:00 AM |
| Contacts | Signed By | Update | Reinstatement | Rogers, Greg Harper
President
MidMichigan Medicat Center - Midland
9898393225 | Cross, Bryan Rex
Vice President
MidMichigan Health
9898391322 | 4/7/2020 11:30 AM |
| Details | Last Recertification Date | Update | Reinstatement | 8/20/2019 8:16:22 AM | | 4/7/2020 11:30 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | Reinstatement | 11/30/2019 12:00:00 AM | | 4/7/2020 11:30 AM |
| Dates | Participating Approval Date | Update | Reinstatement | 10/31/2017 10:08:30 AM | 4/7/2020 11:30:06 AM | 4/7/2020 11:30 AM |
| Details | State | Update | Reinstatement | Terminated | Approved | 4/7/2020 11:30 AM |
| Dates | Registration Date | Update | Reinstatement | 10/6/2017 2:20:06 PM | 4/1/2020 2:52:34 PM | 4/7/2020 11:30 AM |
| Dates | Signed By Date | Update | Reinstatement | 10/6/2017 4:24:10 PM | 4/2/2020 12:05:07 PM | 4/7/2020 11:30 AM |
| Dates | Start Date | Update | Reinstatement | 1/1/2018 12:00:00 AM | 7/1/2020 12:00:00 AM | 4/7/2020 11:30 AM |
| Terminations | Termination Date | Update | Reinstatement | 1/1/2020 12:00:00 AM | | 4/7/2020 11:30 AM |
| Terminations | Termination Effective Date | Update | Reinstatement | 11/30/2019 12:00:00 AM | | 4/7/2020 11:30 AM |
| Terminations | Termination Reason | Update | Reinstatement | DSH percentage below statutory minimum | | 4/7/2020 11:30 AM |
| Contacts | Authorizing Official | Update | Reinstatement | Rogers, Greg Harper
President
MidMichigan Medicat Center - Midland
9898393225 | Cross, Bryan Rex
Vice President
MidMichigan Health
9898391322 | 4/7/2020 11:05 AM |
| Details | Comments Public | Insert | Reinstatement | | Participating start date 1/1/2018, Terminated 1/1/2020; Reinstated 7/1/2020 | 4/2/2020 3:51 PM |
| Details | State | Update | | To Be Terminated | Terminated | 1/1/2020 12:05 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | Termination Request | | 11/30/2019 12:00:00 AM | 12/9/2019 10:03 AM |
| Details | State | Update | Termination Request | Active | To Be Terminated | 12/9/2019 10:03 AM |
| Terminations | Termination Date | Update | Termination Request | | 1/1/2020 12:00:00 AM | 12/9/2019 10:03 AM |
| Terminations | Termination Effective Date | Update | Termination Request | | 11/30/2019 12:00:00 AM | 12/9/2019 10:03 AM |
| Terminations | Termination Reason | Update | Termination Request | | DSH percentage below statutory minimum | 12/9/2019 10:03 AM |
| Details | Last Recertification Date | Update | Recertification | 8/16/2018 5:20:12 PM | 8/20/2019 8:16:22 AM | 8/20/2019 8:16 AM |
| Contacts | Primary Contact | Update | Change Request | Spencer, Kenneth P
Manager Pharmacy Informatics
MidMichigan Health System
9898391522 | Constantine, Eileen
340B Program Coordinator
MidMichigan Medical Center - Gratiot
9894667258 | 7/31/2019 2:27 PM |
| Contacts | Primary Contact | Update | Profile Change Request | Spencer, Kenneth Patrick
Manager Pharmacy Informatics
MidMichigan Health System
9898391522 | Spencer, Kenneth P
Manager Pharmacy Informatics
MidMichigan Health System
9898391522 | 7/30/2019 8:08 AM |
| Contacts | Primary Contact | Update | Recertification | Cross, Bryan
Director of Pharmacy
MidMichigan Health
9898391322 | Spencer, Kenneth Patrick
Manager Pharmacy Informatics
MidMichigan Health System
9898391522 | 8/16/2018 5:20 PM |
| Details | Last Recertification Date | Update | Recertification | | 8/16/2018 5:20:12 PM | 8/16/2018 5:20 PM |
| Addresses | Main Address | Update | Change Request |
4401 N CAMPUS RIDGE DR
MIDLAND, MI 48640-6112 |
4401 CAMPUS RIDGE Drive Suite 1100
MIDLAND, MI 48640-6112 | 1/5/2018 10:12 AM |
| Contacts | Signed By | Insert | New Registration | | Rogers, Greg Harper
President
MidMichigan Medicat Center - Midland
9898393225 | 10/31/2017 10:08 AM |
| Details | 340B ID | Update | New Registration | | SCH230222-15 | 10/31/2017 10:08 AM |
| Details | Entity Subname | Update | New Registration | MIDMICHIGAN CNTR MIDLAND | MIDMICHIGAN CNTR MIDLAND - Internal Medicine - Midland | 10/31/2017 10:08 AM |
| Dates | Participating Approval Date | Update | New Registration | | 10/31/2017 10:08:30 AM | 10/31/2017 10:08 AM |
| Details | State | Update | New Registration | Pending | Approved | 10/31/2017 10:08 AM |
| Dates | Signed By Date | Update | New Registration | | 10/6/2017 4:24:10 PM | 10/31/2017 10:08 AM |
| Dates | Start Date | Update | New Registration | | 1/1/2018 12:00:00 AM | 10/31/2017 10:08 AM |
| Addresses | Main Address | Insert | New Registration | |
4401 N CAMPUS RIDGE DR
MIDLAND, MI 48640-6112 | 10/6/2017 2:20 PM |
| Contacts | Authorizing Official | Insert | New Registration | | Rogers, Greg Harper
President
MidMichigan Medicat Center - Midland
9898393225 | 10/6/2017 2:20 PM |
| Contacts | Primary Contact | Insert | New Registration | | Cross, Bryan
Director of Pharmacy
MidMichigan Health
9898391322 | 10/6/2017 2:20 PM |
| Details | Last Recertification Date | Insert | New Registration | | | 10/6/2017 2:20 PM |
| Details | Grant Number | Insert | New Registration | | | 10/6/2017 2:20 PM |
| Details | 340B ID | Insert | New Registration | | | 10/6/2017 2:20 PM |
| Details | Is Authorizing Official EHB Data | Insert | New Registration | | | 10/6/2017 2:20 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | New Registration | | | 10/6/2017 2:20 PM |
| Details | Medicare Provider Number | Insert | New Registration | | 230222 | 10/6/2017 2:20 PM |
| Details | Entity Name | Insert | New Registration | | MIDMICHIGAN MEDICAL CTR | 10/6/2017 2:20 PM |
| Details | Program Code | Insert | New Registration | | SCH | 10/6/2017 2:20 PM |
| Details | Entity Subname | Insert | New Registration | | MIDMICHIGAN CNTR MIDLAND | 10/6/2017 2:20 PM |
| Dates | Participating Approval Date | Insert | New Registration | | | 10/6/2017 2:20 PM |
| Details | State | Insert | New Registration | | Pending | 10/6/2017 2:20 PM |
| Dates | Registration Date | Insert | New Registration | | 10/6/2017 2:20:06 PM | 10/6/2017 2:20 PM |
| Dates | Signed By Date | Insert | New Registration | | | 10/6/2017 2:20 PM |
| Dates | Start Date | Insert | New Registration | | | 10/6/2017 2:20 PM |
| Terminations | Termination Comments | Insert | New Registration | | | 10/6/2017 2:20 PM |
| Terminations | Termination Date | Insert | New Registration | | | 10/6/2017 2:20 PM |
| Terminations | Termination Effective Date | Insert | New Registration | | | 10/6/2017 2:20 PM |
| Terminations | Termination Reason | Insert | New Registration | | | 10/6/2017 2:20 PM |