Covered Entity Details

RRC230227-32 MCLAREN MACOMB (Terminated) - information as of 5/2/2025 10:32:43 PM

Main Details

Name

MCLAREN MACOMB

Subdivision Name

Country Meadows Family Medicine and Pediatrics - Peds Garfield

Type

Rural Referral Center

Rural

Yes

340B ID

RRC230227-32

Medicare Provider Number

230227

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

10/2/2020

Participating Start Date

12/1/2020

Participating Approval Date

11/13/2020

Last Recertification Date

8/23/2023

Termination Date
Termination Reason

4/1/2024
Site closure

Contacts

Authorizing Official

McLaren Macomb
Steve Snyder, Chief Financial Officer
(586) 493-3044

Primary Contact

McLaren Health Care
Tiffany Harwood, Corporate Director of 340B Data Analytics
(734) 512-8778

Addresses

Street Address

16700 21 Mile Road, Suite 104
Macomb, MI 48044

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	1316938327	1316938327

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
RRC230227-01	Child	RRC	MCLAREN MACOMB	Women's Health Associates - Clinton Township - New Clinton WH	37400 Garfield	Clinton Township	MI	Terminated
RRC230227-02	Child	RRC	MCLAREN MACOMB	Women's Health Associates North Grove - North Grove	44200 Garfield	Clinton Township	MI	Active
RRC230227-03	Child	RRC	MCLAREN MACOMB	Sterling Heights Pediatrics - Sterl Hts Peds Ddg Park	35111 Dodge Park	Sterling Heights	MI	Active
RRC230227-04	Child	RRC	MCLAREN MACOMB	Rehabilitation and Therapy Services Northpointe	37055 S Gratiot Ave	Clinton Township	MI	Active
RRC230227-05	Child	RRC	MCLAREN MACOMB	Primary Care Lakewood - Prim Care Sterl Hts	13425 19 Mile Road	Sterling Heights	MI	Active
RRC230227-06	Child	RRC	MCLAREN MACOMB	Multi-specialty Shelby Township - Shelby Creek	8180 26 Mile Rd	Shelby Township	MI	Terminated
RRC230227-07	Child	RRC	MCLAREN MACOMB	Multi-specialty Shelby Township - PHYSICAL THERAPY-SHELBY	8180 26 Mile Rd	Shelby Township	MI	Terminated
RRC230227-08	Child	RRC	MCLAREN MACOMB	Multi-specialty Shelby Township - OCCUPATIONAL THERAPY-SHELBY	8180 26 Mile Rd	Shelby Township	MI	Terminated
RRC230227-09	Child	RRC	MCLAREN MACOMB	Diagnostic Imaging Shelby Township	8180 26 Mile Rd	Shelby Township	MI	Active
RRC230227-10	Child	RRC	MCLAREN MACOMB	Family Medicine and Women's Health	36500 Gratiot Ave	Clinton Township	MI	Active
RRC230227-11	Child	RRC	MCLAREN MACOMB	Multi-Specialty Clinic	36500 Gratiot Ave	Clinton Township	MI	Active
RRC230227-12	Child	RRC	MCLAREN MACOMB	Family First	36500 Gratiot Ave	Clinton Township	MI	Active
RRC230227-13	Child	RRC	MCLAREN MACOMB	Osteopathic Manipulative Medicine	1030 Harrington Blvd	Mt. Clemens	MI	Active
RRC230227-14	Child	RRC	MCLAREN MACOMB	Mac Neurology Harrington	21510 Harrington Blvd, Suite 200	Clinton Township	MI	Terminated
RRC230227-15	Child	RRC	MCLAREN MACOMB	Cardiovascular Institute	1030 Harrington St	Mt. Clemens	MI	Active
RRC230227-16	Child	RRC	MCLAREN MACOMB	Lakeshore Medical	33720 Harper Ave	Clinton Township	MI	Active
RRC230227-17	Child	RRC	MCLAREN MACOMB	Heart Rhythm Treatment Center and Pain Management - ORTHOPEDICS - NICHOLAS	21550 Harrington Blvd, Ste A	Clinton Township	MI	Terminated
RRC230227-18	Child	RRC	MCLAREN MACOMB	McLaren Center for Spine and Pain Management	21510 Harrington Blvd	Clinton Township	MI	Active
RRC230227-19	Child	RRC	MCLAREN MACOMB	Heart Rhythm and Treatment Center	21510 Harrington Blvd	Clinton Township	MI	Active
RRC230227-20	Child	RRC	MCLAREN MACOMB	Hampton Medical Center - Hampton Med	30550 Utica Road	Roseville	MI	Terminated
RRC230227-21	Child	RRC	MCLAREN MACOMB	Health and Wellness	21510 Harrington Blvd	Clinton Township	MI	Active
RRC230227-22	Child	RRC	MCLAREN MACOMB	Family Medicine - Romeo Plank	46401 Romeo Plank, Suite 4	Macomb	MI	Terminated
RRC230227-23	Child	RRC	MCLAREN MACOMB	Diagnostic Imaging - MAMMOGRAPHY-HARPER IMAGING	36561 Harper Ave Ste F	Clinton Township	MI	Terminated
RRC230227-24	Child	RRC	MCLAREN MACOMB	Diagnostic Imagine, Therapy and Lab Draw Station - Bay River - ULTRASOUND-BAY RIVER	36267 26 Mile Suite 2	Lenox	MI	Terminated
RRC230227-25	Child	RRC	MCLAREN MACOMB	Diagnostic Imagine, Therapy and Lab Draw Station - Bay River - REHAB PT - BAY RIVER	36267 26 Mile Rd Ste 5	Lenox	MI	Terminated
RRC230227-26	Child	RRC	MCLAREN MACOMB	Diagnostic Imagine, Therapy and Lab Draw Station - Bay River - OCCUPATIONAL THERAPY-BAY RIVER	36267 26 Mile Rd Ste 5	Lenox	MI	Terminated
RRC230227-27	Child	RRC	MCLAREN MACOMB	Bay River Diagnostic Imaging	36267 26 Mile	Lenox	MI	Active
RRC230227-28	Child	RRC	MCLAREN MACOMB	Bay River Breast Screening	36267 26 Mile	Lenox	MI	Active
RRC230227-29	Child	RRC	MCLAREN MACOMB	CV Institute, Diagnostic Imaging and Rehab and Therapy - REHAB PT - RICHMOND	66440 Gratiot	Lenox	MI	Terminated
RRC230227-30	Child	RRC	MCLAREN MACOMB	Diagnostic Imaging McLaren Macomb - Richmond/Lenox	66440 Gratiot Ave	Lenox Township	MI	Active
RRC230227-31	Child	RRC	MCLAREN MACOMB	Richmond Breast Screening	66440 Gratiot Ave	Lenox Township	MI	Active
RRC230227-32	Child	RRC	MCLAREN MACOMB	Country Meadows Family Medicine and Pediatrics - Peds Garfield	16700 21 Mile Road, Suite 104	Macomb	MI	Terminated
RRC230227-33	Child	RRC	MCLAREN MACOMB	Country Meadows Family Medicine and Pediatrics - Country Meadows	16700 21 Mile Road, Suite 101	Macomb	MI	Terminated
RRC230227-34	Child	RRC	MCLAREN MACOMB	Clinton Township Pediatrics - Peds Clinton Twp	22500 Metropolitan Parkway	Clinton Township	MI	Active
RRC230227-35	Child	RRC	MCLAREN MACOMB	McLaren Macomb Rheumatology	37399 Garfield	Clinton Township	MI	Active
RRC230227-36	Child	RRC	MCLAREN MACOMB	Clinton Township Family Medicine and Internal Medicine - Clinton Twp Fam Med	37399 Garfield, Suite 203	Clinton Township	MI	Terminated
RRC230227-37	Child	RRC	MCLAREN MACOMB	Clarkston Radiation Oncology Clinic	5680 Bow Pointe Drive	Clarkston	MI	Active
RRC230227-38	Child	RRC	MCLAREN MACOMB	Clarkston Cancer Center - CLARKSON PET/CT	5680 Bow Pointe Drive	Clarkston	MI	Terminated
RRC230227-39	Child	RRC	MCLAREN MACOMB	Orthopedics and Trauma	1030 Harrington St	Mt Clemens	MI	Active
RRC230227-40	Child	RRC	MCLAREN MACOMB	Neurology Services	21510 Harrington Blvd	Clinton Township	MI	Active
RRC230227-41	Child	RRC	MCLAREN MACOMB	McLaren Macomb Family First Medical - Mobile/Outreach Clinic	36500 Gratiot Ave	Clinton Township	MI	Active
RRC230227-42	Child	RRC	MCLAREN MACOMB	McLaren Macomb Diagnostic Imaging Harrington Med Center	21510 Harrington St	Clinton Township	MI	Active
RRC230227-43	Child	RRC	MCLAREN MACOMB	Interventional Radiology	1030 Harrington Blvd	Mt. Clemens	MI	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	4/1/2024 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		2/27/2024 12:00:00 AM	2/28/2024 12:43 PM
Details	State	Update	Termination Request	Active	To Be Terminated	2/28/2024 12:43 PM
Terminations	Termination Date	Update	Termination Request		4/1/2024 12:00:00 AM	2/28/2024 12:43 PM
Terminations	Termination Effective Date	Update	Termination Request		2/28/2024 12:00:00 AM	2/28/2024 12:43 PM
Terminations	Termination Reason	Update	Termination Request		Site closure	2/28/2024 12:43 PM
Contacts	Primary Contact	Update	PC Change Request	Brown, Sharelle Corporate, 340B Program Director McLaren Health Care 2483968085	Harwood, Tiffany Corporate Director of 340B Data Analytics McLaren Health Care 7345128778	2/28/2024 7:57 AM
Details	Last Recertification Date	Update	Recertification	9/16/2022 12:39:22 PM	8/23/2023 1:15:50 PM	8/23/2023 1:15 PM
Contacts	Authorizing Official	Update	Change Request	Balutanski, Brian Regional CFO McLaren Macomb 5864933044	Snyder, Steve Chief Financial Officer McLaren Macomb 5864933044	7/6/2023 12:13 PM
Contacts	Primary Contact	Update	PC Change Request	Felczak, Michael Joseph Regional Director - Reimbursement McLaren Macomb 5866513708	Brown, Sharelle Corporate, 340B Program Director McLaren Health Care 2483968085	9/19/2022 6:59 AM
Details	Last Recertification Date	Update	Recertification	8/30/2021 6:16:22 PM	9/16/2022 12:39:22 PM	9/16/2022 12:39 PM
Details	Last Recertification Date	Update	Recertification		8/30/2021 6:16:22 PM	8/30/2021 6:16 PM
Details	State	Update		Approved	Active	12/1/2020 12:01 AM
Dates	Start Date	Update	OPA Edit	1/1/2021 12:00:00 AM	12/1/2020 12:00:00 AM	11/20/2020 5:13 PM
Contacts	Signed By	Insert	New Registration		Balutanski, Brian Regional CFO McLaren Macomb 5864933044	11/13/2020 9:10 AM
Details	340B ID	Update	New Registration		RRC230227-32	11/13/2020 9:10 AM
Details	Entity Subname	Update	New Registration	Country Meadows Family Medicine and Pediatrics	Country Meadows Family Medicine and Pediatrics - Peds Garfield	11/13/2020 9:10 AM
Dates	Participating Approval Date	Update	New Registration		11/13/2020 9:10:53 AM	11/13/2020 9:10 AM
Details	State	Update	New Registration	Pending	Approved	11/13/2020 9:10 AM
Dates	Signed By Date	Update	New Registration		10/15/2020 4:17:26 PM	11/13/2020 9:10 AM
Dates	Start Date	Update	New Registration		1/1/2021 12:00:00 AM	11/13/2020 9:10 AM
Addresses	Main Address	Insert	New Registration		16700 21 Mile Road, Suite 104 Macomb, MI 48044	10/2/2020 10:23 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/2/2020 10:23 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1316938327	10/2/2020 10:23 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		MI	10/2/2020 10:23 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1316938327	10/2/2020 10:23 AM
Medicaid Billing	NPI: State	Insert	New Registration		MI	10/2/2020 10:23 AM
Contacts	Primary Contact	Insert	New Registration		Felczak, Michael Joseph Regional Director - Reimbursement McLaren Macomb 5866513708	10/2/2020 10:23 AM
Contacts	Authorizing Official	Insert	New Registration		Balutanski, Brian Regional CFO McLaren Macomb 5864933044	10/2/2020 10:23 AM
Details	Assistance Received From Date	Insert	New Registration			10/2/2020 10:23 AM
Details	Assistance Received To Date	Insert	New Registration			10/2/2020 10:23 AM
Details	Last Recertification Date	Insert	New Registration			10/2/2020 10:23 AM
Details	Grant Number	Insert	New Registration			10/2/2020 10:23 AM
Details	340B ID	Insert	New Registration			10/2/2020 10:23 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/2/2020 10:23 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/2/2020 10:23 AM
Details	Medicare Provider Number	Insert	New Registration		230227	10/2/2020 10:23 AM
Details	Entity Name	Insert	New Registration		MCLAREN MACOMB	10/2/2020 10:23 AM
Details	NOFO Number	Insert	New Registration			10/2/2020 10:23 AM
Details	Program Code	Insert	New Registration		RRC	10/2/2020 10:23 AM
Details	Entity Subname	Insert	New Registration		Country Meadows Family Medicine and Pediatrics	10/2/2020 10:23 AM
Dates	Participating Approval Date	Insert	New Registration			10/2/2020 10:23 AM
Details	State	Insert	New Registration		Pending	10/2/2020 10:23 AM
Dates	Registration Date	Insert	New Registration		10/2/2020 10:23:30 AM	10/2/2020 10:23 AM
Dates	Signed By Date	Insert	New Registration			10/2/2020 10:23 AM
Dates	Start Date	Insert	New Registration			10/2/2020 10:23 AM
Terminations	Termination Comments	Insert	New Registration			10/2/2020 10:23 AM
Terminations	Termination Date	Insert	New Registration			10/2/2020 10:23 AM
Terminations	Termination Effective Date	Insert	New Registration			10/2/2020 10:23 AM
Terminations	Termination Reason	Insert	New Registration			10/2/2020 10:23 AM