Contacts | Primary Contact | Update | Group Change Request | Alviar, Lacey
Business Intelligence Analyst
Spectrum Health Hospital
6163911179 | Alviar, Lacey
Business Intell Analyst, Sr
Corewell Health
6163911179 | 12/5/2024 11:31 AM |
Contacts | Authorizing Official | Update | Change Request | Knuth, Amanda
Controller
Corewell Health
2315924305 | Knuth, Amanda
Finance Controller
Corewell Health
2315924305 | 10/28/2024 1:49 PM |
Details | Last Recertification Date | Update | Recertification | 8/28/2023 9:29:08 AM | 8/14/2024 10:13:38 AM | 8/14/2024 10:13 AM |
Details | Entity Name | Update | Change Request | SPECTRUM HEALTH UNITED HOSPITAL | Corewell Health Greenville Hospital | 9/19/2023 2:27 PM |
Details | Entity Subname | Update | Change Request | SPECTRUM HEALTH UNITED - General Surgery | General Surgery | 9/19/2023 2:26 PM |
Details | Last Recertification Date | Update | Recertification | 9/2/2022 12:15:37 PM | 8/28/2023 9:29:08 AM | 8/28/2023 9:29 AM |
Contacts | Authorizing Official | Update | Change Request | Sella, John
Senior Director, Finance
Spectrum Health Gerber
6166439168 | Knuth, Amanda
Controller
Corewell Health
2315924305 | 11/7/2022 1:53 PM |
Details | Last Recertification Date | Update | Recertification | 8/23/2021 10:59:34 AM | 9/2/2022 12:15:37 PM | 9/2/2022 12:15 PM |
Contacts | Authorizing Official | Update | Change Request | Knoerl, Tom
Controller
Spectrum Health
2315924253 | Sella, John
Senior Director, Finance
Spectrum Health Gerber
6166439168 | 6/23/2022 2:23 PM |
Contacts | Primary Contact | Update | Group Change Request | Knol, Angela Marie
Business Intelligence Analyst
Spectrum Health
6167747939 | Alviar, Lacey
Business Intelligence Analyst
Spectrum Health Hospital
6163911179 | 11/23/2021 8:57 AM |
Details | Last Recertification Date | Update | Recertification | 8/24/2020 10:19:18 AM | 8/23/2021 10:59:34 AM | 8/23/2021 10:59 AM |
Medicaid Billing | NPI: State | Update | Recertification | | MI | 8/24/2020 10:19 AM |
Details | Last Recertification Date | Update | Recertification | 9/5/2019 11:48:46 AM | 8/24/2020 10:19:18 AM | 8/24/2020 10:19 AM |
Contacts | Authorizing Official | Update | Change Request | Mahar, Priscilla Kay
Chief Operating and Compliance Officer
Spectrum Health United and Kelsey Hospitals
6162256313 | Knoerl, Tom
Controller
Spectrum Health
2315924253 | 2/28/2020 2:03 PM |
Addresses | Main Address | Update | Recertification |
707 S GREENVILLE WEST DRIVE
SPECTRUM HEALTH UNITED IM/PEDS
GREENVILLE, MI 48838-3514 |
707 S GREENVILLE WEST DRIVE
GREENVILLE, MI 48838-3514 | 9/5/2019 11:48 AM |
Contacts | Primary Contact | Update | Recertification | Volk, Andrew
Director, Pharmacy Business Operations, SHDS
Spectrum Health
6162670072 | Knol, Angela Marie
Business Intelligence Analyst
Spectrum Health
6167747939 | 9/5/2019 11:48 AM |
Details | Last Recertification Date | Update | Recertification | | 9/5/2019 11:48:46 AM | 9/5/2019 11:48 AM |
Details | State | Update | | Approved | Active | 4/1/2019 12:05 AM |
Contacts | Signed By | Insert | New Registration | | Mahar, Priscilla Kay
Chief Operating and Compliance Officer
Spectrum Health United and Kelsey Hospitals
6162256313 | 1/24/2019 10:03 AM |
Details | 340B ID | Update | New Registration | | DSH230035E | 1/24/2019 10:03 AM |
Details | Entity Name | Update | New Registration | SPECTRUM HEALTH UNITED MEMORIAL | SPECTRUM HEALTH UNITED HOSPITAL | 1/24/2019 10:03 AM |
Details | Entity Subname | Update | New Registration | SPECTRUM HEALTH UNITED | SPECTRUM HEALTH UNITED - General Surgery | 1/24/2019 10:03 AM |
Dates | Participating Approval Date | Update | New Registration | | 1/24/2019 10:03:12 AM | 1/24/2019 10:03 AM |
Details | State | Update | New Registration | Pending | Approved | 1/24/2019 10:03 AM |
Dates | Signed By Date | Update | New Registration | | 1/15/2019 10:37:45 AM | 1/24/2019 10:03 AM |
Dates | Start Date | Update | New Registration | | 4/1/2019 12:00:00 AM | 1/24/2019 10:03 AM |
Addresses | Main Address | Insert | New Registration | |
707 S GREENVILLE WEST DRIVE
SPECTRUM HEALTH UNITED IM/PEDS
GREENVILLE, MI 48838-3514 | 1/14/2019 11:01 AM |
Medicaid Billing | NPI: Number | Insert | New Registration | | 1477927184 | 1/14/2019 11:01 AM |
Contacts | Authorizing Official | Insert | New Registration | | Mahar, Priscilla Kay
Chief Operating and Compliance Officer
Spectrum Health United and Kelsey Hospitals
6162256313 | 1/14/2019 11:01 AM |
Contacts | Primary Contact | Insert | New Registration | | Volk, Andrew
Director, Pharmacy Business Operations, SHDS
Spectrum Health
6162670072 | 1/14/2019 11:01 AM |
Details | Last Recertification Date | Insert | New Registration | | | 1/14/2019 11:01 AM |
Details | Grant Number | Insert | New Registration | | | 1/14/2019 11:01 AM |
Details | 340B ID | Insert | New Registration | | | 1/14/2019 11:01 AM |
Details | Is Authorizing Official EHB Data | Insert | New Registration | | | 1/14/2019 11:01 AM |
Dates | Last Date That 340B Drugs Purchased | Insert | New Registration | | | 1/14/2019 11:01 AM |
Details | Medicare Provider Number | Insert | New Registration | | 230035 | 1/14/2019 11:01 AM |
Details | Entity Name | Insert | New Registration | | SPECTRUM HEALTH UNITED MEMORIAL | 1/14/2019 11:01 AM |
Details | Program Code | Insert | New Registration | | DSH | 1/14/2019 11:01 AM |
Details | Entity Subname | Insert | New Registration | | SPECTRUM HEALTH UNITED | 1/14/2019 11:01 AM |
Dates | Participating Approval Date | Insert | New Registration | | | 1/14/2019 11:01 AM |
Details | State | Insert | New Registration | | Pending | 1/14/2019 11:01 AM |
Dates | Registration Date | Insert | New Registration | | 1/14/2019 11:01:38 AM | 1/14/2019 11:01 AM |
Dates | Signed By Date | Insert | New Registration | | | 1/14/2019 11:01 AM |
Dates | Start Date | Insert | New Registration | | | 1/14/2019 11:01 AM |
Terminations | Termination Comments | Insert | New Registration | | | 1/14/2019 11:01 AM |
Terminations | Termination Date | Insert | New Registration | | | 1/14/2019 11:01 AM |
Terminations | Termination Effective Date | Insert | New Registration | | | 1/14/2019 11:01 AM |
Terminations | Termination Reason | Insert | New Registration | | | 1/14/2019 11:01 AM |