Covered Entity Details

SCH230093-05 Corewell Health Big Rapids Hospital (Active) - information as of 6/26/2025 12:24:20 AM

Main Details

Name

Corewell Health Big Rapids Hospital

Subdivision Name

Ob/Gyn

Type

Sole Community Hospital

Rural

Yes

340B ID

SCH230093-05

Medicare Provider Number

230093

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/5/2020

Participating Start Date

1/1/2021

Participating Approval Date

10/28/2020

Last Recertification Date

8/14/2024

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

722 Locust St
Suite 2
Big Rapids, MI 49307

Billing Address

Corewell Health Big Rapids Hospital
605 Oak Street
Big Rapids, MI 49307

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		1891109591

Shipping Addresses

Shipping Address 1

Corewell Health Big Rapids Hospital
605 Oak Street
Big Rapids, MI 49307

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
SCH230093-01	Child	SCH	Spectrum Health Big Rapids Hospital	Occupation Medicine	705 Oak Street	Big Rapids	MI	Terminated
SCH230093-02	Child	SCH	Corewell Health Big Rapids Hospital	Family Medicine - Canadian Lakes	8354 100TH AVE	STANWOOD	MI	Active
SCH230093-03	Child	SCH	Corewell Health Big Rapids Hospital	Family Medicine - Big Rapids	14755 215th Ave.	Big Rapids	MI	Active
SCH230093-04	Child	SCH	Corewell Health Big Rapids Hospital	Family Medicine - Evart	5991 95th Avenue	Evart	MI	Active
SCH230093-05	Child	SCH	Corewell Health Big Rapids Hospital	Ob/Gyn	722 Locust St	Big Rapids	MI	Active
SCH230093-06	Child	SCH	Spectrum Health System - Big Rapids Hospital	Rural Health Clinic - Tustin Family Medicine	111 E. Church Street	Tustin	MI	Terminated
SCH230093-07	Child	SCH	Corewell Health Big Rapids Hospital	Big Rapids - Walk-in Clinics	14755 215th Ave.	Big Rapids	MI	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
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	12/5/2024 10:42 AM
Contacts	Authorizing Official	Update	Change Request	Knuth, Amanda Controller Corewell Health 2315924305	Knuth, Amanda Finance Controller Corewell Health 2315924305	10/28/2024 12:30 PM
Addresses	Main Address	Update	Change Request	722 LOCUST STREET BIG RAPIDS, MI 49307-2040	722 Locust St Suite 2 Big Rapids, MI 49307	10/15/2024 12:39 PM
Addresses	Billing Address	Insert	Change Request		Corewell Health Big Rapids Hospital 605 Oak Street Big Rapids, MI 49307	10/15/2024 12:39 PM
Addresses	Shipping Address	Insert	Change Request		Corewell Health Big Rapids Hospital 605 Oak Street Big Rapids, MI 49307	10/15/2024 12:39 PM
Details	Last Recertification Date	Update	Recertification	8/28/2023 9:28:50 AM	8/14/2024 10:13:52 AM	8/14/2024 10:13 AM
Details	Entity Subname	Update	Change Request	Big Rapids - OBGYN	Ob/Gyn	9/19/2023 2:25 PM
Details	Entity Name	Update	Change Request	Spectrum Health System - Big Rapids Hospital	Corewell Health Big Rapids Hospital	9/19/2023 2:24 PM
Details	Last Recertification Date	Update	Recertification	9/2/2022 12:18:02 PM	8/28/2023 9:28:50 AM	8/28/2023 9:28 AM
Contacts	Authorizing Official	Update	Change Request	Sella, John Senior Director, Finance Spectrum Health Gerber 6166439168	Knuth, Amanda Controller Corewell Health 2315924305	11/9/2022 7:31 AM
Details	Last Recertification Date	Update	Recertification	8/23/2021 11:03:43 AM	9/2/2022 12:18:02 PM	9/2/2022 12:18 PM
Contacts	Authorizing Official	Update	Change Request	Knoerl, Tom Controller Spectrum Health 2315924253	Sella, John Senior Director, Finance Spectrum Health Gerber 6166439168	6/23/2022 2:22 PM
Details	Entity Name	Update	Change Request	Spectrum Health Big Rapids Hospital	Spectrum Health System - Big Rapids Hospital	3/3/2022 12:09 PM
Details	Entity Subname	Update	Change Request	MECOSTA COUNTY MEDICAL CENTER - OBGYN	Big Rapids - OBGYN	11/24/2021 9:14 AM
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	11/23/2021 9:29 AM
Details	Last Recertification Date	Update	Recertification		8/23/2021 11:03:43 AM	8/23/2021 11:03 AM
Details	State	Update		Approved	Active	1/1/2021 12:01 AM
Contacts	Signed By	Insert	New Registration		Knoerl, Tom Controller Spectrum Health 2315924253	10/28/2020 9:02 AM
Details	340B ID	Update	New Registration		SCH230093-05	10/28/2020 9:02 AM
Details	Entity Name	Update	New Registration	SPECTRUM HEALTH BIG RAPIDS	Spectrum Health Big Rapids Hospital	10/28/2020 9:02 AM
Details	Entity Subname	Update	New Registration	MECOSTA COUNTY MEDICAL CENTER	MECOSTA COUNTY MEDICAL CENTER - OBGYN	10/28/2020 9:02 AM
Dates	Participating Approval Date	Update	New Registration		10/28/2020 9:02:12 AM	10/28/2020 9:02 AM
Details	State	Update	New Registration	Pending	Approved	10/28/2020 9:02 AM
Dates	Signed By Date	Update	New Registration		10/9/2020 1:02:52 PM	10/28/2020 9:02 AM
Dates	Start Date	Update	New Registration		1/1/2021 12:00:00 AM	10/28/2020 9:02 AM
Addresses	Main Address	Insert	New Registration		722 LOCUST STREET BIG RAPIDS, MI 49307-2040	10/5/2020 8:42 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1891109591	10/5/2020 8:42 AM
Medicaid Billing	NPI: State	Insert	New Registration		MI	10/5/2020 8:42 AM
Contacts	Authorizing Official	Insert	New Registration		Knoerl, Tom Controller Spectrum Health 2315924253	10/5/2020 8:42 AM
Contacts	Primary Contact	Insert	New Registration		Knol, Angela Marie Business Intelligence Analyst Spectrum Health 6167747939	10/5/2020 8:42 AM
Details	Assistance Received From Date	Insert	New Registration			10/5/2020 8:42 AM
Details	Assistance Received To Date	Insert	New Registration			10/5/2020 8:42 AM
Details	Last Recertification Date	Insert	New Registration			10/5/2020 8:42 AM
Details	Grant Number	Insert	New Registration			10/5/2020 8:42 AM
Details	340B ID	Insert	New Registration			10/5/2020 8:42 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/5/2020 8:42 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/5/2020 8:42 AM
Details	Medicare Provider Number	Insert	New Registration		230093	10/5/2020 8:42 AM
Details	Entity Name	Insert	New Registration		SPECTRUM HEALTH BIG RAPIDS	10/5/2020 8:42 AM
Details	NOFO Number	Insert	New Registration			10/5/2020 8:42 AM
Details	Program Code	Insert	New Registration		SCH	10/5/2020 8:42 AM
Details	Entity Subname	Insert	New Registration		MECOSTA COUNTY MEDICAL CENTER	10/5/2020 8:42 AM
Dates	Participating Approval Date	Insert	New Registration			10/5/2020 8:42 AM
Details	State	Insert	New Registration		Pending	10/5/2020 8:42 AM
Dates	Registration Date	Insert	New Registration		10/5/2020 8:42:48 AM	10/5/2020 8:42 AM
Dates	Signed By Date	Insert	New Registration			10/5/2020 8:42 AM
Dates	Start Date	Insert	New Registration			10/5/2020 8:42 AM
Terminations	Termination Comments	Insert	New Registration			10/5/2020 8:42 AM
Terminations	Termination Date	Insert	New Registration			10/5/2020 8:42 AM
Terminations	Termination Effective Date	Insert	New Registration			10/5/2020 8:42 AM
Terminations	Termination Reason	Insert	New Registration			10/5/2020 8:42 AM