Covered Entity Details

DSH230059BS SAINT MARY'S HEALTH CARE (Active) - information as of 5/2/2025 10:41:07 PM

Main Details

Name

SAINT MARY'S HEALTH CARE

Subdivision Name

MHPP Sparta Health Clinic - Family Medicine

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH230059BS

Medicare Provider Number

230059

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

7/15/2020

Participating Start Date

10/1/2020

Participating Approval Date

8/27/2020

Last Recertification Date

9/5/2024

Contacts

Authorizing Official

Trinity Health Muskegon Hospital
Daniel G. Green, Vice President for Finance
(616) 685-6709

Primary Contact

Saint Mary's Health Care
Robert D Bird, 340B Program Manager
(616) 685-1107

Addresses

Street Address

475 South State Street
Sparta, MI 49345

Billing Address

Mercy Health Saint Mary's
200 Jefferson Ave SE
Grand Rapids, MI 49503

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
DSH230059A	Child	DSH	SAINT MARY'S HEALTH CARE	Mercy Health Saint Mary's Kidney Transplant Program	310 Lafayette Ave SE, Suite 315	Grand Rapids	MI	Active
DSH230059AA	Child	DSH	SAINT MARY'S HEALTH CARE	MHPP GR Vascular Surgery	310 Lafayette SE, Suite 301	Grand Rapids	MI	Active
DSH230059AB	Child	DSH	SAINT MARY'S HEALTH CARE	MHPP OBGYN Downtown Office	245 Cherry St SE, Suite 306	Grand Rapids	MI	Active
DSH230059AC	Child	DSH	SAINT MARY'S HEALTH CARE	MHPP SouthWest	2373 64th St SW	Byron Center	MI	Active
DSH230059AD	Child	DSH	SAINT MARY'S HEALTH CARE	MHPP Wege Specialty Residency	300 Lafayette SE, Suite 3200	Grand Rapids	MI	Active
DSH230059AE	Child	DSH	SAINT MARY'S HEALTH CARE	MHPP Wege Specialty Pulmonology	310 Lafayette SE, Suite 415	Grand Rapids	MI	Active
DSH230059AF	Child	DSH	SAINT MARY'S HEALTH CARE	MHPP Wege Family Medicine Private	300 Lafayette SE, Suite 4200	Grand Rapids	MI	Terminated
DSH230059AG	Child	DSH	SAINT MARY'S HEALTH CARE	MHPP Neurology Opthalmology	245 Cherry St, Suite 204	Grand Rapids	MI	Active
DSH230059AH	Child	DSH	SAINT MARY'S HEALTH CARE	MHPP NeuroSurgery	245 Cherry St, Suite 300	Grand Rapids	MI	Active
DSH230059AJ	Child	DSH	SAINT MARY'S HEALTH CARE	MHPP Geriatrics	200 Jefferson Ave SE	Grand Rapids	MI	Active
DSH230059AK	Child	DSH	SAINT MARY'S HEALTH CARE	MHPP Epilepsy Clinic	245 Cherry St, Suite 104	Grand Rapids	MI	Active
DSH230059AL	Child	DSH	SAINT MARY'S HEALTH CARE	MHPP Hauenstein Neuro-Psychology	245 Cherry St, Suite 200	Grand Rapids	MI	Active
DSH230059AM	Child	DSH	SAINT MARY'S HEALTH CARE	MHPP GR Vascular Surgery SW	2373 64th Street SW, Suite 1304	Byron Center	MI	Active
DSH230059AN	Child	DSH	SAINT MARY'S HEALTH CARE	MHPP Browning Claytor	1246 Madison Ave SE	GRAND RAPIDS	MI	Terminated
DSH230059AP	Child	DSH	SAINT MARY'S HEALTH CARE	MHPP Sparta Health Center	475 South State St SE	Sparta	MI	Terminated
DSH230059AQ	Child	DSH	SAINT MARY'S HEALTH CARE	Wyoming Family Practice	950 36th Street SW	Wyoming	MI	Terminated
DSH230059AR	Child	DSH	SAINT MARY'S HEALTH CARE	Mercy Health Urgent Care Rockford	6050 Northland Drive NE	Rockford	MI	Terminated
DSH230059AS	Child	DSH	SAINT MARY'S HEALTH CARE	MHPP Holland North	3290 North Wellnes Drive	Holland	MI	Terminated
DSH230059AT	Child	DSH	SAINT MARY'S HEALTH CARE	MHPP Internal Medicine - Internal Medicine East Paris	2144 East Paris Avenue SE	Grand Rapids	MI	Active
DSH230059AU	Child	DSH	SAINT MARY'S HEALTH CARE	MHPP Innovative Primary Care - People Centered Primary Care	801 Broadway Avenue NW, Suite 105	Grand Rapids	MI	Terminated
DSH230059AV	Child	DSH	SAINT MARY'S HEALTH CARE	MHPP Holland North - Herman Miller - Family Medicine	18511 171st Avenue	Spring Lake	MI	Terminated
DSH230059AW	Child	DSH	SAINT MARY'S HEALTH CARE	MHPP Rockford - Boulder Creek - Family Medicine	6070 Northland Drive	Rockford	MI	Terminated
DSH230059AX	Child	DSH	SAINT MARY'S HEALTH CARE	MHPP Downtown OB - Holland Clinic - OB	3290 Wellness Drive, Suite 220	Holland	MI	Terminated
DSH230059AY	Child	DSH	SAINT MARY'S HEALTH CARE	MHPP Vascular Surgery - Holland North Clinic - Vascular Surgery	3290 Wellness Drive, Suite 220	Holland	MI	Terminated
DSH230059AZ	Child	DSH	SAINT MARY'S HEALTH CARE	MHPP Lacks GYN/Onc - Muskegon - GYN ONC	1787 Wagner Avenue	Muskegon	MI	Terminated
DSH230059B	Child	DSH	SAINT MARY'S HEALTH CARE	MHPP - Wege Family Medicine Residency	300 Lafayette SE, Suite 4000	Grand Rapids	MI	Active
DSH230059BA	Child	DSH	SAINT MARY'S HEALTH CARE	MHPP Downtown OB - Southwest Clinic - OB	2373 64th Street SW	Byron Center	MI	Active
DSH230059BB	Child	DSH	SAINT MARY'S HEALTH CARE	MHPP Lacks Gyn/Onc - Holland North - GYN ONC	3290 Wellness Drive, Suite 220	Holland	MI	Terminated
DSH230059BC	Child	DSH	SAINT MARY'S HEALTH CARE	MHPP Downtown OB at MHPP Rockford - OB	6050 Northland Drive, Suite 200	Rockford	MI	Active
DSH230059BD	Child	DSH	SAINT MARY'S HEALTH CARE	MHPP Southeast - Wedgewood Clinic - Family Practice	3300 36th St SE	Grand Rapids	MI	Terminated
DSH230059BE	Child	DSH	SAINT MARY'S HEALTH CARE	MHPP Vascular Surgery - Ada - Vascular Surgery	6741 East Fulton	Ada	MI	Terminated
DSH230059BF	Child	DSH	SAINT MARY'S HEALTH CARE	MHPP OB Gyn Downtown - Ada - OB Gyn	6741 East Fulton	Ada	MI	Terminated
DSH230059BG	Child	DSH	SAINT MARY'S HEALTH CARE	MHPP Neurology - Ada - Neurology	6741 East Fulton	Ada	MI	Terminated
DSH230059BH	Child	DSH	SAINT MARY'S HEALTH CARE	MHPP Downtown OB Gyn - Northwest - OB Gyn	933 3 Mile Road NW	Grand Rapids	MI	Terminated
DSH230059BJ	Child	DSH	SAINT MARY'S HEALTH CARE	MHPP OBGYN DTO EAST PARIS	2144 East Paris Ave, Suite 200	Grand Rapids	MI	Active
DSH230059BK	Child	DSH	SAINT MARY'S HEALTH CARE	MHPP OBGYN DTO HUDSONVILLE	3925 32nd Avenue, Suite 300	Hudsonville	MI	Active
DSH230059BL	Child	DSH	SAINT MARY'S HEALTH CARE	Mercy Health Urgent Care Hudsonville - Urgent Care	3925 32nd Ave	Hudsonville	MI	Terminated
DSH230059BM	Child	DSH	SAINT MARY'S HEALTH CARE	MHPP Advanced Care Coordination Program	245 Cherry Street SE, Suite 204	Grand Rapids	MI	Active
DSH230059BN	Child	DSH	SAINT MARY'S HEALTH CARE	MHPP Ada - Family Medicine	6741 East Fulton, Suite 201	Ada	MI	Terminated
DSH230059BP	Child	DSH	SAINT MARY'S HEALTH CARE	MHPP Hudsonville - Family Medicine	3925 32nd Ave, Suite 300	Hudsonville	MI	Active
DSH230059BQ	Child	DSH	SAINT MARY'S HEALTH CARE	MHPP Pulmonary Southwest - Pulmonology	2373 64th Street SW, Suite 1300	Byron Center	MI	Active
DSH230059BR	Child	DSH	SAINT MARY'S HEALTH CARE	Clinica Santa Maria - Family Medicine	730 Grandville Ave SE	Grand Rapids	MI	Active
DSH230059BS	Child	DSH	SAINT MARY'S HEALTH CARE	MHPP Sparta Health Clinic - Family Medicine	475 South State Street	Sparta	MI	Active
DSH230059BT	Child	DSH	SAINT MARY'S HEALTH CARE	Browning Claytor Health Center - Family Medicine	1246 Madison Ave SE	Grand Rapids	MI	Active
DSH230059BU	Child	DSH	SAINT MARY'S HEALTH CARE	Hepatitis C Clinic - Infectious Disease	310 Lafayette Ave SE, Suite 410	Grand Rapids	MI	Active
DSH230059BV	Child	DSH	SAINT MARY'S HEALTH CARE	Mercy Health Wege Anticoagulation Clinic - Anticoagulation Management	300 Lafayette Ave SER	Grand Rapids	MI	Active
DSH230059BW	Child	DSH	SAINT MARY'S HEALTH CARE	Hauenstein Sleep Clinic Grand Rapids - Neurology	245 Cherry St SE, Suite 200	Grand Rapids	MI	Active
DSH230059BX	Child	DSH	SAINT MARY'S HEALTH CARE	Mercy Health Sleep Lab - Neurology	245 Cherry St SE, Suite 200	Grand Rapids	MI	Active
DSH230059BY	Child	DSH	SAINT MARY'S HEALTH CARE	Mercy Health Physical Medicine and Spine - Physical Medicine	245 Cherry Street SE, Suite 300	Grand Rapids	MI	Active
DSH230059BZ	Child	DSH	SAINT MARY'S HEALTH CARE	Women's Health and Fertility Clinic - OB/Gyn	6050 Northland Drive NE, Suite 200	Rockford	MI	Terminated
DSH230059C	Child	DSH	SAINT MARY'S HEALTH CARE	MHPP - Wege Internal Medicine Residency Center	300 Lafayette SE, Suite 3000	Grand Rapids	MI	Active
DSH230059CA	Child	DSH	SAINT MARY'S HEALTH CARE	Hauenstein Spine Rehabilitation Clinic - Neurospine	245 Cherry St SE, Suite 300	Grand Rapids	MI	Active
DSH230059CB	Child	DSH	SAINT MARY'S HEALTH CARE	Mercy Health Southwest Coag Clinic - Hematology	2373 64th Street SW	Byron Center	MI	Active
DSH230059CC	Child	DSH	SAINT MARY'S HEALTH CARE	Mercy Health Internal Medicine Private Practice - Internal Medicine	300 Lafayette SE, Suite 3000	Grand Rapids	MI	Active
DSH230059CD	Child	DSH	SAINT MARY'S HEALTH CARE	MHPP GASTROENTEROLOGY - MHPP GASTROENTEROLOGY	310 Lafayette Ave SE Suite 400	Grand Rapids	MI	Active
DSH230059CE	Child	DSH	SAINT MARY'S HEALTH CARE	MHPP RHEUMATOLOGY - MHPP RHEUMATOLOGY	1155 E Paris SE STE 100	Grand Rapids	MI	Active
DSH230059CF	Child	DSH	SAINT MARY'S HEALTH CARE	TH Urogynecology GR - TH Urogynecology GR	2144 E Paris Ave SE Ste 200	Grand Rapids	MI	Active
DSH230059CG	Child	DSH	SAINT MARY'S HEALTH CARE	MGRRF Emergency - MGRRF Emergency	6050 Northland Dr NE	Grand Rapids	MI	Active
DSH230059CH	Child	DSH	SAINT MARY'S HEALTH CARE	MGRRF MHPP NEUROSCIENCE ROCKFORD - MGRRF MHPP NEUROSCIENCE ROCKFORD	6050 Northland Dr NE Suite 200	Rockford	MI	Approved
DSH230059D	Child	DSH	SAINT MARY'S HEALTH CARE	MHPP Grand River Cardiology	1000 East Paris SE, Suite 200	Grand Rapids	MI	Active
DSH230059E	Child	DSH	SAINT MARY'S HEALTH CARE	MHPP- Neuroscience Clinics	220 Cherry SE, Hauenstein 1	Grand Rapids	MI	Active
DSH230059F	Child	DSH	SAINT MARY'S HEALTH CARE	The Lacks Cancer Center	250 Cherry SE	Grand Rapids	MI	Active
DSH230059G	Child	DSH	SAINT MARY'S HEALTH CARE	MHPP Endocrinology and Diabetes Clinic	300 Lafayette SE, Suite 2045	Grand Rapids	MI	Active
DSH230059H	Child	DSH	SAINT MARY'S HEALTH CARE	MHPP Wound Care	310 Lafayette SE, Suite 220	Grand Rapids	MI	Active
DSH230059J	Child	DSH	SAINT MARY'S HEALTH CARE	Mercy Health Saint Mary's Southwest Emergency	2373 64th St. SW	Byron Center	MI	Active
DSH230059K	Child	DSH	SAINT MARY'S HEALTH CARE	Saint Mary's East Beltline Urgent Care Center	1471 East Beltline NE	Grand Rapids	MI	Terminated
DSH230059L	Child	DSH	SAINT MARY'S HEALTH CARE	Saint Mary's Infectious Disease Clinic	310 Lafayette SE, Suite 410	Grand Rapids	MI	Active
DSH230059M	Child	DSH	SAINT MARY'S HEALTH CARE	Pine Rest - Adult Partial Program	Van Andel Center	Grand Rapids	MI	Terminated
DSH230059N	Child	DSH	SAINT MARY'S HEALTH CARE	MHPP Walker/Standale Office	1175 Wilson Ave NW	Walker	MI	Active
DSH230059P	Child	DSH	SAINT MARY'S HEALTH CARE	MHPP Southeast Office	2080 44th Street SE	Kentwood	MI	Active
DSH230059Q	Child	DSH	SAINT MARY'S HEALTH CARE	East Beltline OB/Gyn	1471 East Beltline NE	Grand Rapids	MI	Terminated
DSH230059R	Child	DSH	SAINT MARY'S HEALTH CARE	MHPP Rivertown Office	3380 44th St SW	Grandville	MI	Active
DSH230059S	Child	DSH	SAINT MARY'S HEALTH CARE	MHPP Northwest Office	933 3 Mile Road NW	Grand Rapids	MI	Active
DSH230059T	Child	DSH	SAINT MARY'S HEALTH CARE	MHPP - Rockford	6050 Northland Drive	Rockford	MI	Active
DSH230059U	Child	DSH	SAINT MARY'S HEALTH CARE	MHPP Jenison Office	7782 20th Avenue	Jenison	MI	Active
DSH230059V	Child	DSH	SAINT MARY'S HEALTH CARE	MHPP East Beltline Office	1471 East Beltline NE	Grand Rapids	MI	Active
DSH230059W	Child	DSH	SAINT MARY'S HEALTH CARE	MHPP Downtown Office	245 Cherry St, SE	Grand Rapids	MI	Active
DSH230059X	Child	DSH	SAINT MARY'S HEALTH CARE	MHPP Caledonia Office	10047 Crossroad Ct.	Caledonia	MI	Active
DSH230059Y	Child	DSH	SAINT MARY'S HEALTH CARE	MHPP Grand River Cardiology Downtown	310 Lafayette SE, Suite 300	GRAND RAPIDS	MI	Active
DSH230059Z	Child	DSH	SAINT MARY'S HEALTH CARE	MHPP Grand River Cardiology SouthWest	2373 64th St SW, Suite 1304	Byron Center	MI	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	9/10/2023 9:06:00 PM	9/5/2024 9:56:46 PM	9/5/2024 9:56 PM
Contacts	Primary Contact	Update	Group Change Request	Kirkpatrick, Terry Director of Pharmacy Services DSH230059 6166856108	Bird, Robert D 340B Program Manager Saint Mary's Health Care 6166851107	6/4/2024 8:39 AM
Details	Last Recertification Date	Update	Recertification	9/16/2022 7:49:45 AM	9/10/2023 9:06:00 PM	9/10/2023 9:06 PM
Contacts	Authorizing Official	Update	AO Change Request	Green, Daniel G. Vice President for Finance Mercy Health Saint Mary's 6166856709	Green, Daniel G. Vice President for Finance Trinity Health Muskegon Hospital 6166856709	8/24/2023 9:06 AM
Details	Last Recertification Date	Update	Recertification	9/10/2021 3:11:50 PM	9/16/2022 7:49:45 AM	9/16/2022 7:49 AM
Details	Last Recertification Date	Update	Recertification		9/10/2021 3:11:50 PM	9/10/2021 3:11 PM
Details	Entity Subname	Update	Change Request	MHPP Rockford at Sparta Health Clinic - Family Medicine	MHPP Sparta Health Clinic - Family Medicine	7/15/2021 12:47 PM
Details	State	Update		Approved	Active	10/1/2020 12:01 AM
Contacts	Signed By	Insert	New Registration		Green, Daniel G. Vice President for Finance Mercy Health Saint Mary's 6166856709	8/27/2020 1:57 PM
Details	340B ID	Update	New Registration		DSH230059BS	8/27/2020 1:57 PM
Details	Entity Name	Update	New Registration	SAINT MARYS HEALTH CARE	SAINT MARY'S HEALTH CARE	8/27/2020 1:57 PM
Details	Entity Subname	Update	New Registration	MHPP Rockford at Sparta Health Clinic	MHPP Rockford at Sparta Health Clinic - Family Medicine	8/27/2020 1:57 PM
Dates	Participating Approval Date	Update	New Registration		8/27/2020 1:57:56 PM	8/27/2020 1:57 PM
Details	State	Update	New Registration	Pending	Approved	8/27/2020 1:57 PM
Dates	Signed By Date	Update	New Registration		7/15/2020 1:34:24 PM	8/27/2020 1:57 PM
Dates	Start Date	Update	New Registration		10/1/2020 12:00:00 AM	8/27/2020 1:57 PM
Addresses	Main Address	Insert	New Registration		475 South State Street Sparta, MI 49345	7/15/2020 12:54 PM
Addresses	Billing Address	Insert	New Registration		Mercy Health Saint Mary's 200 Jefferson Ave SE Grand Rapids, MI 49503	7/15/2020 12:54 PM
Contacts	Authorizing Official	Insert	New Registration		Green, Daniel G. Vice President for Finance Mercy Health Saint Mary's 6166856709	7/15/2020 12:54 PM
Contacts	Primary Contact	Insert	New Registration		Kirkpatrick, Terry Director of Pharmacy Services DSH230059 6166856108	7/15/2020 12:54 PM
Details	Last Recertification Date	Insert	New Registration			7/15/2020 12:54 PM
Details	Grant Number	Insert	New Registration			7/15/2020 12:54 PM
Details	340B ID	Insert	New Registration			7/15/2020 12:54 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/15/2020 12:54 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/15/2020 12:54 PM
Details	Medicare Provider Number	Insert	New Registration		230059	7/15/2020 12:54 PM
Details	Entity Name	Insert	New Registration		SAINT MARYS HEALTH CARE	7/15/2020 12:54 PM
Details	Program Code	Insert	New Registration		DSH	7/15/2020 12:54 PM
Details	Entity Subname	Insert	New Registration		MHPP Rockford at Sparta Health Clinic	7/15/2020 12:54 PM
Dates	Participating Approval Date	Insert	New Registration			7/15/2020 12:54 PM
Details	State	Insert	New Registration		Pending	7/15/2020 12:54 PM
Dates	Registration Date	Insert	New Registration		7/15/2020 12:54:24 PM	7/15/2020 12:54 PM
Dates	Signed By Date	Insert	New Registration			7/15/2020 12:54 PM
Dates	Start Date	Insert	New Registration			7/15/2020 12:54 PM
Terminations	Termination Comments	Insert	New Registration			7/15/2020 12:54 PM
Terminations	Termination Date	Insert	New Registration			7/15/2020 12:54 PM
Terminations	Termination Effective Date	Insert	New Registration			7/15/2020 12:54 PM
Terminations	Termination Reason	Insert	New Registration			7/15/2020 12:54 PM