Covered Entity Details

CAH521356-03 Oconto Hospital & Medical Center, Inc. dba Bellin Health Oconto Hospital (Active) - information as of 5/5/2025 11:53:45 PM

Main Details

Name

Oconto Hospital & Medical Center, Inc. dba Bellin Health Oconto Hospital

Subdivision Name

OCONTO HOSPITAL & MED CENTER INC - Bellin Health Menominee, a department of Bellin Health Oconto Hospital

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH521356-03

Medicare Provider Number

521356

Outpatient Facility Provider Number

238705

Additional Details

Current Program Status

Active

Registration Date

10/15/2019

Participating Start Date

1/1/2020

Participating Approval Date

11/15/2019

Last Recertification Date

8/14/2024

Contacts

Authorizing Official

Oconto Hospital & Medical Center, Inc.dba Bellin Health Oconto Hospital
Julie Ann Bulin, Vice President
(920) 835-2932

Primary Contact

Oconto Hospital & Medical Center Inc dba Bellin Health Oconto Hospital
Jason E Knox, Pharmacist
(715) 735-2213

Addresses

Street Address

1100 10TH ST
BELLIN HEALTH MENOMINEE
MENOMINEE, MI 49858-3062

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?
No

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
CAH521356-01	Child	CAH	Oconto Hospital & Medical Center, Inc. dba Bellin Health Oconto Hospital	OCONTO HOSPITAL AND MEDICAL CENTER - Marinette Oncology & Infusion	2820 ROOSEVELT RD	MARINETTE	WI	Active
CAH521356-02	Child	CAH	Oconto Hospital & Medical Center, Inc. dba Bellin Health Oconto Hospital	OCONTO HOSPITAL AND MEDICAL CENTER - Bellin Health Crivitz, a department of Bellin Health Oconto Hospital	218 S HWY 141	CRIVITZ	WI	Active
CAH521356-03	Child	CAH	Oconto Hospital & Medical Center, Inc. dba Bellin Health Oconto Hospital	OCONTO HOSPITAL & MED CENTER INC - Bellin Health Menominee, a department of Bellin Health Oconto Hospital	1100 10TH ST	MENOMINEE	MI	Active
CAH521356-04	Child	CAH	Oconto Hospital & Medical Center, Inc. dba Bellin Health Oconto Hospital	OCONTO HOSPITAL AND MEDICAL CENTER - Bellin Health Oconto, a department of Bellin Health Oconto Hospital	820 ARBUTUS AVE	OCONTO	WI	Active
CAH521356-05	Child	CAH	Oconto Hospital & Medical Center, Inc. dba Bellin Health Oconto Hospital	OCONTO HOSPITAL & MED CENTER INC - Bellin Health Daggett, a department of Bellin Health Oconto Hospital	106 S SCHOOL ROAD	DAGGETT	MI	Active
CAH521356-06	Child	CAH	Oconto Hospital & Medical Center, Inc. dba Bellin Health Oconto Hospital	OCONTO HOSPITAL & MEDICAL CENTER IN - Bellin Health Peshtigo, a department of Bellin Health Oconto Hospital	441 FRENCH ST	PESHTIGO	WI	Active
CAH521356-07	Child	CAH	Oconto Hospital & Medical Center, Inc. dba Bellin Health Oconto Hospital	OCONTO HOSPITAL AND MEDICAL CENTER - Marinette Specialty Care	2820 ROOSEVELT ROAD	MARINETTE	WI	Active
CAH521356-08	Child	CAH	Oconto Hospital & Medical Center, Inc. dba Bellin Health Oconto Hospital	OCONTO HOSPITAL AND MEDICAL CENTER - Urgent Care: Marinette	2820 ROOSEVELT ROAD	MARINETTE	WI	Active
CAH521356-09	Child	CAH	Oconto Hospital & Medical Center, Inc. dba Bellin Health Oconto Hospital	OCONTO HOSPITAL AND MEDICAL CENTER - Marinette OBGYN	2820 ROOSEVELT ROAD	MARINETTE	WI	Active
CAH521356-10	Child	CAH	Oconto Hospital & Medical Center, Inc. dba Bellin Health Oconto Hospital	OCONTO HOSPITAL AND MEDICAL CENTER - EC: Marinette County	2820 ROOSEVELT ROAD	MARINETTE	WI	Active
CAH521356-11	Child	CAH	Oconto Hospital & Medical Center, Inc. dba Bellin Health Oconto Hospital	OCONTO HOSPITAL AND MEDICAL CENTER - FP: Marinette	2820 ROOSEVELT ROAD	MARINETTE	WI	Active
CAH521356-12	Child	CAH	Oconto Hospital & Medical Center, Inc. dba Bellin Health Oconto Hospital	OCONTO HOSPITAL AND MEDICAL CENTER - OCONTO HOSPITAL AND MEDICAL CENTER - Bellin Health Oconto Falls, a department of Bellin Health Oconto Hospital	107 E HIGHLAND DR	OCONTO FALLS	WI	Active
CAH521356-13	Child	CAH	Oconto Hospital & Medical Center, Inc. dba Bellin Health Oconto Hospital	OCONTO HOSPITAL & MEDICAL CENTER IN - Bellin Health Suring, a department of Bellin Health Oconto Hospital	307 MANOR DR	SURING	WI	Active
CAH521356-14	Child	CAH	Oconto Hospital & Medical Center, Inc. dba Bellin Health Oconto Hospital	OCONTO HOSPITAL & MEDICAL CENTER IN - Bellin Health Lakewood, a department of Bellin Health Oconto Hospital	15481 COMMERCIAL RD	LAKEWOOD	WI	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	AO Change Request	Bulin, Julie Ann VP Oconto Hospital and Clinics Oconto Hospital & Medical Center Inc dba Bellin Health Oconto Hospital 9208352932	Bulin, Julie Ann Vice President Oconto Hospital & Medical Center, Inc.dba Bellin Health Oconto Hospital 9208352932	4/15/2025 3:06 PM
Contacts	Primary Contact	Update	Group Change Request	Knox, Jason E Pharmacist Oconto Hospital & Medical Center, Inc. dba Bellin Health Oconto Hospital 7157352213	Knox, Jason E Pharmacist Oconto Hospital & Medical Center Inc dba Bellin Health Oconto Hospital 7157352213	4/15/2025 3:00 PM
Contacts	Authorizing Official	Update	Change Request	Bieber, Julie Ann VP Oconto Hospital and Clinics Oconto Hospital & Medical Center Inc dba Bellin Health Oconto Hospital 9208352932	Bulin, Julie Ann VP Oconto Hospital and Clinics Oconto Hospital & Medical Center Inc dba Bellin Health Oconto Hospital 9208352932	11/26/2024 2:28 PM
Details	Last Recertification Date	Update	Recertification	8/16/2023 8:30:05 AM	8/14/2024 11:34:39 AM	8/14/2024 11:34 AM
Details	Last Recertification Date	Update	Recertification	9/7/2022 4:58:59 PM	8/16/2023 8:30:05 AM	8/16/2023 8:30 AM
Details	Last Recertification Date	Update	Recertification	8/25/2021 8:46:06 AM	9/7/2022 4:58:59 PM	9/7/2022 4:58 PM
Details	Last Recertification Date	Update	Recertification	8/21/2020 9:04:59 AM	8/25/2021 8:46:06 AM	8/25/2021 8:46 AM
Details	Last Recertification Date	Update	Recertification		8/21/2020 9:04:59 AM	8/21/2020 9:04 AM
Contacts	Authorizing Official	Update	AO Change Request	Cormier, Laura L CEO Oconto Hospital & Medical Center, Inc. dba Bellin Health Oconto Hospital 9208351101	Bieber, Julie Ann VP Oconto Hospital and Clinics Oconto Hospital & Medical Center Inc dba Bellin Health Oconto Hospital 9208352932	7/6/2020 12:21 PM
Details	State	Update		Approved	Active	1/1/2020 12:04 AM
Contacts	Signed By	Insert	New Registration		Cormier, Laura L CEO Oconto Hospital & Medical Center, Inc. dba Bellin Health Oconto Hospital 9208351101	11/15/2019 2:28 PM
Details	340B ID	Update	New Registration		CAH521356-03	11/15/2019 2:28 PM
Details	Entity Name	Update	New Registration	OCONTO HOSPITAL & MEDICAL CENTER	Oconto Hospital & Medical Center, Inc. dba Bellin Health Oconto Hospital	11/15/2019 2:28 PM
Details	Entity Subname	Update	New Registration	OCONTO HOSPITAL & MED CENTER INC	OCONTO HOSPITAL & MED CENTER INC - Bellin Health Menominee, a department of Bellin Health Oconto Hospital	11/15/2019 2:28 PM
Dates	Participating Approval Date	Update	New Registration		11/15/2019 2:28:19 PM	11/15/2019 2:28 PM
Details	State	Update	New Registration	Pending	Approved	11/15/2019 2:28 PM
Dates	Signed By Date	Update	New Registration		10/15/2019 4:11:40 PM	11/15/2019 2:28 PM
Dates	Start Date	Update	New Registration		1/1/2020 12:00:00 AM	11/15/2019 2:28 PM
Addresses	Main Address	Insert	New Registration		1100 10TH ST BELLIN HEALTH MENOMINEE MENOMINEE, MI 49858-3062	10/15/2019 3:59 PM
Contacts	Authorizing Official	Insert	New Registration		Cormier, Laura L CEO Oconto Hospital & Medical Center, Inc. dba Bellin Health Oconto Hospital 9208351101	10/15/2019 3:59 PM
Contacts	Primary Contact	Insert	New Registration		Knox, Jason E Pharmacist Oconto Hospital & Medical Center, Inc. dba Bellin Health Oconto Hospital 7157352213	10/15/2019 3:59 PM
Details	Last Recertification Date	Insert	New Registration			10/15/2019 3:59 PM
Details	Grant Number	Insert	New Registration			10/15/2019 3:59 PM
Details	340B ID	Insert	New Registration			10/15/2019 3:59 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/15/2019 3:59 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/15/2019 3:59 PM
Details	Medicare Provider Number	Insert	New Registration		521356	10/15/2019 3:59 PM
Details	Entity Name	Insert	New Registration		OCONTO HOSPITAL & MEDICAL CENTER	10/15/2019 3:59 PM
Details	Program Code	Insert	New Registration		CAH	10/15/2019 3:59 PM
Details	Entity Subname	Insert	New Registration		OCONTO HOSPITAL & MED CENTER INC	10/15/2019 3:59 PM
Dates	Participating Approval Date	Insert	New Registration			10/15/2019 3:59 PM
Details	State	Insert	New Registration		Pending	10/15/2019 3:59 PM
Dates	Registration Date	Insert	New Registration		10/15/2019 3:59:35 PM	10/15/2019 3:59 PM
Dates	Signed By Date	Insert	New Registration			10/15/2019 3:59 PM
Dates	Start Date	Insert	New Registration			10/15/2019 3:59 PM
Terminations	Termination Comments	Insert	New Registration			10/15/2019 3:59 PM
Terminations	Termination Date	Insert	New Registration			10/15/2019 3:59 PM
Terminations	Termination Effective Date	Insert	New Registration			10/15/2019 3:59 PM
Terminations	Termination Reason	Insert	New Registration			10/15/2019 3:59 PM