Covered Entity Details

SCH230110-05 Corewell Health Ludington Hospital (Active) - information as of 5/14/2025 10:59:15 PM

Main Details

Name

Corewell Health Ludington Hospital

Subdivision Name

Family Medicine - Hart

Type

Sole Community Hospital

Rural

Yes

340B ID

SCH230110-05

Medicare Provider Number

230110

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

7/13/2020

Participating Start Date

10/1/2020

Participating Approval Date

7/21/2020

Last Recertification Date

8/22/2024

Contacts

Authorizing Official

Corewell Health
Amanda Knuth, Finance Controller
(231) 592-4305

Primary Contact

Corewell Health
Lacey Alviar, Business Intell Analyst, Sr
(616) 391-1179

Addresses

Street Address

2481 N 72ND AVE
HART, MI 49420-8008

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		1861800674

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
SCH230110-01	Child	SCH	Corewell Health Ludington Hospital	Cancer Center	7 ATKINSON DR	LUDINGTON	MI	Terminated
SCH230110-02	Child	SCH	Corewell Health Ludington Hospital	Family Medicine - Hesperia	78 N Division St.	Hesperia	MI	Active
SCH230110-03	Child	SCH	Corewell Health Ludington Hospital	Family Medicine - Grant	230 S Maple St.	Grant	MI	Active
SCH230110-04	Child	SCH	Corewell Health Ludington Hospital	Internal Medicine	7 Atkinson Dr.	Ludington	MI	Active
SCH230110-05	Child	SCH	Corewell Health Ludington Hospital	Family Medicine - Hart	2481 N 72ND AVE	HART	MI	Active
SCH230110-06	Child	SCH	Corewell Health Ludington Hospital	Family Medicine/Internal Medicine/Walk-in - Lawndale	922 Lawndale St.	Ludington	MI	Active
SCH230110-07	Child	SCH	Corewell Health Ludington Hospital	Pediatric Medicine	907 E. Tinkham Ave.	Ludington	MI	Active
SCH230110-08	Child	SCH	Corewell Health Ludington Hospital	Urology	7 Atkinson Dr.	Ludington	MI	Active
SCH230110-09	Child	SCH	Corewell Health Ludington Hospital	Ob/Gyn	7 Atkinson Dr.	Ludington	MI	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Change Request	Sella, John Michael Controller Corewell Health 2319241391	Knuth, Amanda Finance Controller Corewell Health 2315924305	3/28/2025 1:26 PM
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	12/10/2024 12:09 PM
Contacts	Authorizing Official	Update	Change Request	Sella, John Senior Director, Finance Spectrum Health Gerber 6166439168	Sella, John Michael Controller Corewell Health 2319241391	11/5/2024 9:37 AM
Details	Last Recertification Date	Update	Recertification	8/25/2023 2:30:36 PM	8/22/2024 1:18:24 PM	8/22/2024 1:18 PM
Addresses	Main Address	Update	Change Request	2481 N 72ND AVE SPECTRUM HEALTH FAMILY MEDICINE HART, MI 49420-8008	2481 N 72ND AVE HART, MI 49420-8008	9/18/2023 3:50 PM
Details	Entity Subname	Update	Change Request	MEMORIAL MEDICAL CENTER OF WEST MI - Hart Family Medicine	Family Medicine - Hart	9/18/2023 3:50 PM
Details	Entity Name	Update	Change Request	SPECTRUM HEALTH LUDINGTON	Corewell Health Ludington Hospital	9/18/2023 3:49 PM
Details	Last Recertification Date	Update	Recertification	9/2/2022 12:06:53 PM	8/25/2023 2:30:36 PM	8/25/2023 2:30 PM
Details	Last Recertification Date	Update	Recertification	8/26/2021 9:09:27 AM	9/2/2022 12:06:53 PM	9/2/2022 12:06 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	11/29/2021 7:30 AM
Details	Last Recertification Date	Update	Recertification		8/26/2021 9:09:27 AM	8/26/2021 9:09 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	1861800674 (MI)		2/16/2021 7:03 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1861800674	2/16/2021 7:03 AM
Medicaid Billing	NPI: State	Insert	Change Request		MI	2/16/2021 7:03 AM
Details	State	Update		Approved	Active	10/1/2020 12:01 AM
Contacts	Signed By	Insert	New Registration		Sella, John Senior Director, Finance Spectrum Health Gerber 6166439168	7/21/2020 4:18 PM
Details	340B ID	Update	New Registration		SCH230110-05	7/21/2020 4:18 PM
Details	Entity Subname	Update	New Registration	MEMORIAL MEDICAL CENTER OF WEST MI	MEMORIAL MEDICAL CENTER OF WEST MI - Hart Family Medicine	7/21/2020 4:18 PM
Dates	Participating Approval Date	Update	New Registration		7/21/2020 4:18:46 PM	7/21/2020 4:18 PM
Details	State	Update	New Registration	Pending	Approved	7/21/2020 4:18 PM
Dates	Signed By Date	Update	New Registration		7/14/2020 11:48:35 AM	7/21/2020 4:18 PM
Dates	Start Date	Update	New Registration		10/1/2020 12:00:00 AM	7/21/2020 4:18 PM
Addresses	Main Address	Insert	New Registration		2481 N 72ND AVE SPECTRUM HEALTH FAMILY MEDICINE HART, MI 49420-8008	7/13/2020 11:34 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/13/2020 11:34 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1861800674	7/13/2020 11:34 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		MI	7/13/2020 11:34 AM
Contacts	Authorizing Official	Insert	New Registration		Sella, John Senior Director, Finance Spectrum Health Gerber 6166439168	7/13/2020 11:34 AM
Contacts	Primary Contact	Insert	New Registration		Knol, Angela Marie Business Intelligence Analyst Spectrum Health 6167747939	7/13/2020 11:34 AM
Details	Last Recertification Date	Insert	New Registration			7/13/2020 11:34 AM
Details	Grant Number	Insert	New Registration			7/13/2020 11:34 AM
Details	340B ID	Insert	New Registration			7/13/2020 11:34 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/13/2020 11:34 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/13/2020 11:34 AM
Details	Medicare Provider Number	Insert	New Registration		230110	7/13/2020 11:34 AM
Details	Entity Name	Insert	New Registration		SPECTRUM HEALTH LUDINGTON	7/13/2020 11:34 AM
Details	Program Code	Insert	New Registration		SCH	7/13/2020 11:34 AM
Details	Entity Subname	Insert	New Registration		MEMORIAL MEDICAL CENTER OF WEST MI	7/13/2020 11:34 AM
Dates	Participating Approval Date	Insert	New Registration			7/13/2020 11:34 AM
Details	State	Insert	New Registration		Pending	7/13/2020 11:34 AM
Dates	Registration Date	Insert	New Registration		7/13/2020 11:34:23 AM	7/13/2020 11:34 AM
Dates	Signed By Date	Insert	New Registration			7/13/2020 11:34 AM
Dates	Start Date	Insert	New Registration			7/13/2020 11:34 AM
Terminations	Termination Comments	Insert	New Registration			7/13/2020 11:34 AM
Terminations	Termination Date	Insert	New Registration			7/13/2020 11:34 AM
Terminations	Termination Effective Date	Insert	New Registration			7/13/2020 11:34 AM
Terminations	Termination Reason	Insert	New Registration			7/13/2020 11:34 AM