Covered Entity Details

DSH230017AJ BRONSON METHODIST HOSPITAL (Active) - information as of 4/24/2025 11:12:38 PM

Main Details

Name

BRONSON METHODIST HOSPITAL

Subdivision Name

BMH PEDS CENTRE - BRONSON PEDIATRICS - STADIUM DR.

Type

Disproportionate Share Hospital

Rural

340B ID

DSH230017AJ

Medicare Provider Number

230017

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

4/6/2020

Participating Start Date

7/1/2020

Participating Approval Date

4/29/2020

Last Recertification Date

8/28/2024

Contacts

Authorizing Official

Bronson Healthcare Group
James B. Falahee Jr., Sr. Vice President, Legal & Legislative Affairs
(269) 341-8907

Primary Contact

Bronson Healthcare Group
Troy Shirley, System Director of Pharmacy
(269) 341-8157

Addresses

Street Address

2680 W CENTRE AVE
PORTAGE, MI 49024-4828

Billing Address

BRONSON ACCOUNTS PAYABLE
P.O. BOX 4001
KALAMAZOO, MI 49003

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		1831116441

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
DSH230017A	Child	DSH	BRONSON METHODIST HOSPITAL	BRONSON HOME AND AMBULATORY INFUSION CARE	601 JOHN ST	KALAMAZOO	MI	Active
DSH230017AA	Child	DSH	BRONSON METHODIST HOSPITAL	BMH ORTHO JOINT PP - BRONSON ORTHOPEDICS AND JOINT SPECIALISTS	451 HEALTH PKWY	PAW PAW	MI	Active
DSH230017AB	Child	DSH	BRONSON METHODIST HOSPITAL	BRONSON CANCER CENTER - KALAMAZOO	805 JOHN ST	KALAMAZOO	MI	Active
DSH230017AC	Child	DSH	BRONSON METHODIST HOSPITAL	BMH DIAB AND ENDOCRIN - BRONSON DIABETES & ENDOCRINOLOGY CTR	7901 S 12TH ST	PORTAGE	MI	Active
DSH230017AD	Child	DSH	BRONSON METHODIST HOSPITAL	BRONSON PEDIATRIC CARDIOLOGY - BRONSON PEDIATRIC CARDIOLOGY	601 JOHN ST	KALAMAZOO	MI	Active
DSH230017AE	Child	DSH	BRONSON METHODIST HOSPITAL	BRONSON PEDIATRIC HEMATOLOGY ONCOLO - BRONSON PEDIATRIC HEMATOLOGY/ONCOLOGY	601 JOHN ST	KALAMAZOO	MI	Active
DSH230017AF	Child	DSH	BRONSON METHODIST HOSPITAL	BMH BAR MED - BRONSON BARIATRIC AND METABOLIC SPECIALISTS	7901 S 12TH ST STE 200	PORTAGE	MI	Terminated
DSH230017AG	Child	DSH	BRONSON METHODIST HOSPITAL	BRONSON SLEEP HEALTH - BRONSON SLEEP HEALTH SPECIALISTS	3200 W CENTRE AVE	PORTAGE	MI	Active
DSH230017AH	Child	DSH	BRONSON METHODIST HOSPITAL	BRONSON APNEA & NEONATOLOGY CLINIC - BRONSON NEWBORN PULMONARY MULTIDISCIPLINARY CLINIC	601 JOHN ST	KALAMAZOO	MI	Active
DSH230017AJ	Child	DSH	BRONSON METHODIST HOSPITAL	BMH PEDS CENTRE - BRONSON PEDIATRICS - STADIUM DR.	2680 W CENTRE AVE	PORTAGE	MI	Active
DSH230017AK	Child	DSH	BRONSON METHODIST HOSPITAL	BMH FM GROVES - BRONSON FAMILY MEDICINE THE GROVES	6938 ELM VALLEY DR	KALAMAZOO	MI	Active
DSH230017AL	Child	DSH	BRONSON METHODIST HOSPITAL	BMH IM STADIUM - BRONSON INTERNAL MEDICINE STADIUM	5629 STADIUM DR	KALAMAZOO	MI	Active
DSH230017AM	Child	DSH	BRONSON METHODIST HOSPITAL	BMH PEDS SURGERY - BRONSON PEDIATRIC SURGERY SPECIALISTS	601 JOHN ST	KALAMAZOO	MI	Active
DSH230017AN	Child	DSH	BRONSON METHODIST HOSPITAL	BMH BREAST SURGERY - BRONSON BREAST SURGERY SPECIALISTS	601 JOHN ST	KALAMAZOO	MI	Active
DSH230017AP	Child	DSH	BRONSON METHODIST HOSPITAL	BMH PULMONARY PP - BRONSON PULMONARY MEDICINE SPECIALISTS	451 HEALTH PKWY	PAW PAW	MI	Active
DSH230017AQ	Child	DSH	BRONSON METHODIST HOSPITAL	BMH MATERNAL FETAL MED - BRONSON MATERNAL FETAL MEDICINE	252 E LOVELL	KALAMAZOO	MI	Active
DSH230017AR	Child	DSH	BRONSON METHODIST HOSPITAL	BMH PEDS GI - BRONSON PEDIATRIC GASTROENTEROLOGY	601 JOHN ST	KALAMAZOO	MI	Active
DSH230017AS	Child	DSH	BRONSON METHODIST HOSPITAL	BMH RHEUMATOLOGY JOHN - BRONSON RHEUMATOLOGY SPECIALISTS	601 JOHN ST	KALAMAZOO	MI	Active
DSH230017AT	Child	DSH	BRONSON METHODIST HOSPITAL	BMH AFTER HOURS CLINIC - BRONSON AFTER HOURS CLINIC	5629 STADIUM DR	KALAMAZOO	MI	Active
DSH230017AU	Child	DSH	BRONSON METHODIST HOSPITAL	BMH SPINE SCOLIOSIS - BRONSON SPINE AND SCOLIOSIS SPECIALISTS	601 JOHN ST	KALAMAZOO	MI	Active
DSH230017AV	Child	DSH	BRONSON METHODIST HOSPITAL	BMH UROLOGY PP - BRONSON UROLOGY AND CONTINENCE SPECIALISTS	451 HEALTH PKWY	PAW PAW	MI	Active
DSH230017AW	Child	DSH	BRONSON METHODIST HOSPITAL	BMH NEUROLOGY PP - BRONSON NEUROSCIENCE CENTER PAW PAW	451 HEALTH PKWY	PAW PAW	MI	Active
DSH230017AX	Child	DSH	BRONSON METHODIST HOSPITAL	BMH SPORTS MEDICINE - BRONSON SPORTS MEDICINE SPECIALISTS	315 TURWILL LN	KALAMAZOO	MI	Active
DSH230017AY	Child	DSH	BRONSON METHODIST HOSPITAL	BMH FM VICKSBURG - BRONSON FAMILY MEDICINE VICKSBURG	13320 N BOULEVARD ST	VICKSBURG	MI	Active
DSH230017AZ	Child	DSH	BRONSON METHODIST HOSPITAL	BMH UROLOGY CONT GULL - BRONSON UROLOGY AND CONTINENCE SPECIALISTS	1535 GULL RD	KALAMAZOO	MI	Active
DSH230017BA	Child	DSH	BRONSON METHODIST HOSPITAL	BMH OB/GYN CENTRE - BRONSON OBSTETRICS AND GYNECOLOGY	52375 N Main Street	Mattawan	MI	Active
DSH230017BB	Child	DSH	BRONSON METHODIST HOSPITAL	BMH GYN PP - BRONSON OBSTETRICS AND GYNECOLOGY	451 HEALTH PKWY	PAW PAW	MI	Active
DSH230017BC	Child	DSH	BRONSON METHODIST HOSPITAL	BMH FM STADIUM - BRONSON FAMILY MEDICINE STADIUM DR	5629 STADIUM DR	KALAMAZOO	MI	Active
DSH230017BD	Child	DSH	BRONSON METHODIST HOSPITAL	BMH ADULT GASTROENTEROLOGY - BRONSON GASTROENTEROLOGY SPECIALISTS	601 JOHN ST	KALAMAZOO	MI	Active
DSH230017BE	Child	DSH	BRONSON METHODIST HOSPITAL	BMH CARDIOTHOR VASC PP - BRONSON CARDIOTHORACIC ENDOVASCULAR AND VASCULAR SPECIALISTS	451 HEALTH PKWY	PAW PAW	MI	Active
DSH230017BG	Child	DSH	BRONSON METHODIST HOSPITAL	BMH PULMONARY KAZOO - BRONSON PULMONARY MEDICINE SPECIALISTS	535 S BURDICK ST	KALAMAZOO	MI	Active
DSH230017BH	Child	DSH	BRONSON METHODIST HOSPITAL	BMH COLON RECTAL BC - BRONSON COLON AND RECTAL SURGERY BATTLE CREEK	3770 CAPITAL AVE SW	BATTLE CREEK	MI	Active
DSH230017BJ	Child	DSH	BRONSON METHODIST HOSPITAL	BPCP - 9TH STREET - Family Medicine	5973 BEATRICE DRIVE	KALAMAZOO	MI	Active
DSH230017BK	Child	DSH	BRONSON METHODIST HOSPITAL	BPCP - W. MAIN - Family Medicine	6210 W. MAIN ST	KALAMAZOO	MI	Active
DSH230017BL	Child	DSH	BRONSON METHODIST HOSPITAL	BPCP - TEXAS CORNERS - Family Medicine	8088 VINEYARD PKWY	KALAMAZOO	MI	Active
DSH230017BM	Child	DSH	BRONSON METHODIST HOSPITAL	BPCP - GALESBURG - Family Medicine	10310 MILLER DR	GALESBURG	MI	Active
DSH230017BN	Child	DSH	BRONSON METHODIST HOSPITAL	BPCP - RICHLAND - Family Medicine	8906 M-89 HIGHWAY	RICHLAND	MI	Active
DSH230017BP	Child	DSH	BRONSON METHODIST HOSPITAL	BPCP - E. CENTRE - Family Medicine	2700 E. CENTRE	PORTAGE	MI	Active
DSH230017BQ	Child	DSH	BRONSON METHODIST HOSPITAL	BPCP - THREE RIVERS - Family Medicine	601 S. HIGHWAY 131	THREE RIVERS	MI	Active
DSH230017BR	Child	DSH	BRONSON METHODIST HOSPITAL	Bronson Obstetrics and Gynecology Specialists - Kalamazoo - Obstetrics and Gynecology	2854 S 11th Street	Kalamazoo	MI	Active
DSH230017BS	Child	DSH	BRONSON METHODIST HOSPITAL	BMH Rheumatology Drake - Rheumatology	501 S Drake Rd	Kalamazoo	MI	Active
DSH230017C	Child	DSH	BRONSON METHODIST HOSPITAL	Bronson Center for Sleep Disorders	451 Health Parkway	Paw Paw	MI	Terminated
DSH230017D	Child	DSH	BRONSON METHODIST HOSPITAL	Bronson Vicksburg Outpatient Center	13326 N. Boulevard Street	Vicksburg	MI	Terminated
DSH230017E	Child	DSH	BRONSON METHODIST HOSPITAL	Bronson Outpatient Surgery Center - Walnut	125 W Walnut Street	Kalamazoo	MI	Active
DSH230017F	Child	DSH	BRONSON METHODIST HOSPITAL	Bronson West Michigan Cancer Center Infusion Center	200 N. Park ST	Kalamazoo	MI	Terminated
DSH230017G	Child	DSH	BRONSON METHODIST HOSPITAL	Family Medicine John St	601 JOHN ST	KALAMAZOO	MI	Active
DSH230017H	Child	DSH	BRONSON METHODIST HOSPITAL	INTERNAL MEDICINE John St	601 JOHN ST	KALAMAZOO	MI	Active
DSH230017J	Child	DSH	BRONSON METHODIST HOSPITAL	INTERNAL MEDICINE W CENTRE	2600 W CENTRE AVE	PORTAGE	MI	Active
DSH230017K	Child	DSH	BRONSON METHODIST HOSPITAL	BRONSON NEUROSCIENCE CENTER KALAMAZOO	601 JOHN ST	KALAMAZOO	MI	Active
DSH230017L	Child	DSH	BRONSON METHODIST HOSPITAL	BMH GENERAL AND ENDOCRINE SURGERY SPECIALISTS	601 JOHN ST	KALAMAZOO	MI	Active
DSH230017M	Child	DSH	BRONSON METHODIST HOSPITAL	BRONSON UROLOGY AND CONTINENCE SPECIALISTS JOHN ST	601 JOHN ST	KALAMAZOO	MI	Active
DSH230017N	Child	DSH	BRONSON METHODIST HOSPITAL	BMH FM SHAFFER - BRONSON FAMILY MEDICINE SHAFFER	1820 SHAFFER ST	KALAMAZOO	MI	Active
DSH230017P	Child	DSH	BRONSON METHODIST HOSPITAL	BMH PEDS STADIUM - BRONSON RAMBLING ROAD PEDIATRICS OSHTEMO	5629 STADIUM DR	KALAMAZOO	MI	Active
DSH230017Q	Child	DSH	BRONSON METHODIST HOSPITAL	BMH IM PEDS LIFETIME - BRONSON INTERNAL MEDICINE AND PEDIATRICS - LIFETIME WELLNESS	4613 W MAIN ST	KALAMAZOO	MI	Active
DSH230017R	Child	DSH	BRONSON METHODIST HOSPITAL	BMH WOMENS SERVICES - BRONSON WOMENS SERVICES DOWNTOWN	601 JOHN ST	KALAMAZOO	MI	Active
DSH230017S	Child	DSH	BRONSON METHODIST HOSPITAL	BMH ORTHO JOINT JOHN - BRONSON ORTHOPEDICS AND JOINT SPECIALISTS	601 JOHN ST	KALAMAZOO	MI	Active
DSH230017T	Child	DSH	BRONSON METHODIST HOSPITAL	BMH TRMA FOOT ANKLE - BRONSON TRAUMA FOOT AND ANKLE SPECIALISTS	601 JOHN ST	KALAMAZOO	MI	Active
DSH230017U	Child	DSH	BRONSON METHODIST HOSPITAL	BMH COLON RECTAL KZ - BRONSON COLON AND RECTAL SURGERY	601 JOHN ST	KALAMAZOO	MI	Active
DSH230017V	Child	DSH	BRONSON METHODIST HOSPITAL	BMH HAND TH - BRONSON HAND AND ELBOW SURGERY SPECIALISTS	601 JOHN ST	KALAMAZOO	MI	Active
DSH230017W	Child	DSH	BRONSON METHODIST HOSPITAL	BMH HAND ELBOW SURG - BRONSON HAND AND ELBOW SURGERY SPECIALISTS	601 JOHN ST	KALAMAZOO	MI	Active
DSH230017X	Child	DSH	BRONSON METHODIST HOSPITAL	BMH FM CENTRE - BRONSON FAMILY MEDICINE CENTRE ST	52375 N Main Street	Mattawan	MI	Active
DSH230017Y	Child	DSH	BRONSON METHODIST HOSPITAL	BMH CARDIOTHOR VASC - BRONSON CARDIOTHORACIC SURGERY SPECIALISTS	601 JOHN ST	KALAMAZOO	MI	Active
DSH230017Z	Child	DSH	BRONSON METHODIST HOSPITAL	BMH GASTROENT PORTAGE - BRONSON GASTROENTEROLOGY PORTAGE	3304 COOLEY CT	PORTAGE	MI	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Medicaid Billing	NPI: Number	Delete	Group Change Request	1417961137 (MI)		11/12/2024 11:11 AM
Details	Last Recertification Date	Update	Recertification	8/23/2023 7:28:45 AM	8/28/2024 9:09:10 AM	8/28/2024 9:09 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1417961137	1/24/2024 3:41 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MI	1/24/2024 3:41 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1831116441	1/24/2024 3:41 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MI	1/24/2024 3:41 PM
Details	Last Recertification Date	Update	Recertification	8/31/2022 8:57:11 AM	8/23/2023 7:28:45 AM	8/23/2023 7:28 AM
Details	Last Recertification Date	Update	Recertification	8/19/2021 9:24:58 AM	8/31/2022 8:57:11 AM	8/31/2022 8:57 AM
Details	Last Recertification Date	Update	Recertification	8/18/2020 2:42:08 PM	8/19/2021 9:24:58 AM	8/19/2021 9:24 AM
Contacts	Primary Contact	Update	Profile Change Request	Shirley, Troy System Director of Pharmacy Bronson Mehtodist Hospital 2693418157	Shirley, Troy System Director of Pharmacy Bronson Healthcare Group 2693418157	12/3/2020 8:26 AM
Details	Last Recertification Date	Update	Recertification		8/18/2020 2:42:08 PM	8/18/2020 2:42 PM
Contacts	Primary Contact	Update	Change Request	Phillips, Shaun Vice President, Clinical and Pharmacy Services Bronson 2692455987	Shirley, Troy System Director of Pharmacy Bronson Mehtodist Hospital 2693418157	8/7/2020 1:12 PM
Details	State	Update		Approved	Active	7/1/2020 12:00 AM
Contacts	Signed By	Insert	New Registration		Falahee Jr., James B. Sr. Vice President, Legal & Legislative Affairs Bronson Healthcare Group 2693418907	4/29/2020 8:59 AM
Details	340B ID	Update	New Registration		DSH230017AJ	4/29/2020 8:59 AM
Details	Entity Subname	Update	New Registration	BMH PEDS CENTRE	BMH PEDS CENTRE - BRONSON PEDIATRICS - STADIUM DR.	4/29/2020 8:59 AM
Dates	Participating Approval Date	Update	New Registration		4/29/2020 8:59:18 AM	4/29/2020 8:59 AM
Details	State	Update	New Registration	Pending	Approved	4/29/2020 8:59 AM
Dates	Signed By Date	Update	New Registration		4/6/2020 4:35:17 PM	4/29/2020 8:59 AM
Dates	Start Date	Update	New Registration		7/1/2020 12:00:00 AM	4/29/2020 8:59 AM
Addresses	Main Address	Insert	New Registration		2680 W CENTRE AVE PORTAGE, MI 49024-4828	4/6/2020 4:18 PM
Addresses	Billing Address	Insert	New Registration		BRONSON ACCOUNTS PAYABLE P.O. BOX 4001 KALAMAZOO, MI 49003	4/6/2020 4:18 PM
Contacts	Authorizing Official	Insert	New Registration		Falahee Jr., James B. Sr. Vice President, Legal & Legislative Affairs Bronson Healthcare Group 2693418907	4/6/2020 4:18 PM
Contacts	Primary Contact	Insert	New Registration		Phillips, Shaun Vice President, Clinical and Pharmacy Services Bronson 2692455987	4/6/2020 4:18 PM
Details	Last Recertification Date	Insert	New Registration			4/6/2020 4:18 PM
Details	Grant Number	Insert	New Registration			4/6/2020 4:18 PM
Details	340B ID	Insert	New Registration			4/6/2020 4:18 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/6/2020 4:18 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/6/2020 4:18 PM
Details	Medicare Provider Number	Insert	New Registration		230017	4/6/2020 4:18 PM
Details	Entity Name	Insert	New Registration		BRONSON METHODIST HOSPITAL	4/6/2020 4:18 PM
Details	Program Code	Insert	New Registration		DSH	4/6/2020 4:18 PM
Details	Entity Subname	Insert	New Registration		BMH PEDS CENTRE	4/6/2020 4:18 PM
Dates	Participating Approval Date	Insert	New Registration			4/6/2020 4:18 PM
Details	State	Insert	New Registration		Pending	4/6/2020 4:18 PM
Dates	Registration Date	Insert	New Registration		4/6/2020 4:18:24 PM	4/6/2020 4:18 PM
Dates	Signed By Date	Insert	New Registration			4/6/2020 4:18 PM
Dates	Start Date	Insert	New Registration			4/6/2020 4:18 PM
Terminations	Termination Comments	Insert	New Registration			4/6/2020 4:18 PM
Terminations	Termination Date	Insert	New Registration			4/6/2020 4:18 PM
Terminations	Termination Effective Date	Insert	New Registration			4/6/2020 4:18 PM
Terminations	Termination Reason	Insert	New Registration			4/6/2020 4:18 PM