Covered Entity Details

RRC230141-11 MCLAREN FLINT (Active) - information as of 4/28/2025 12:42:37 AM

Main Details

Name

MCLAREN FLINT

Subdivision Name

McLaren Proton Therapy Center - Proton Therapy

Type

Rural Referral Center

Rural

Yes

340B ID

RRC230141-11

Medicare Provider Number

230141

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

12/18/2020

Participating Start Date

12/22/2020

Participating Approval Date

12/22/2020

Last Recertification Date

8/26/2024

Contacts

Authorizing Official

McLaren Flint
FRED KORTE, CFO
(248) 338-5691

Primary Contact

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

Addresses

Street Address

4100 Beecher Rd
Flint, MI 48532

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		1902894512

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
RRC230141-01	Child	RRC	MCLAREN FLINT	Behavioral Health OP Services - Behavioral Health Services	4448 Oak Bridge Dr	Flint	MI	Active
RRC230141-02	Child	RRC	MCLAREN FLINT	Mclaren MRI Flint - MRI Services	750 S Ballenger Hwy	Flint	MI	Active
RRC230141-03	Child	RRC	MCLAREN FLINT	Owosso Radiation - Radiation Oncology	721 N Shiawassee St	Owosso	MI	Active
RRC230141-04	Child	RRC	MCLAREN FLINT	Kamanos Cancer Institute-Flint Radiation - Radiation Oncology	4100 Beecher Rd	Flint	MI	Active
RRC230141-05	Child	RRC	MCLAREN FLINT	Flushing Community Medical Center - Primary Care / Internal Medicine	2487 N Elms Road	Flushing	MI	Active
RRC230141-06	Child	RRC	MCLAREN FLINT	Kamanos Cancer Institute-Lapeer Radiation - Radiation Oncology	1295 Barry Dr	Lapeer	MI	Terminated
RRC230141-07	Child	RRC	MCLAREN FLINT	McLaren Pulmonary Rehabilitation Program - Respiratory Therapy	G-3230 Beecher Rd	Flint	MI	Active
RRC230141-08	Child	RRC	MCLAREN FLINT	Fenton Community Medical Center - Primary Care / Internal Medicine	2420 Owen Rd	Fenton	MI	Active
RRC230141-09	Child	RRC	MCLAREN FLINT	Specialty Center (Wound Care Center/Hyperbaric Oxygen Center) - Wound Clinic	G-3200 Beecher Rd	Flint	MI	Active
RRC230141-10	Child	RRC	MCLAREN FLINT	Physical Therapy Flushing - Physical Therapy	2500 N Elms Rd	Flushing	MI	Active
RRC230141-11	Child	RRC	MCLAREN FLINT	McLaren Proton Therapy Center - Proton Therapy	4100 Beecher Rd	Flint	MI	Active
RRC230141-12	Child	RRC	MCLAREN FLINT	Davison Community Medical Center - Primary Care / Internal Medicine	10090 E Lippincott Blvd	Davison	MI	Active
RRC230141-13	Child	RRC	MCLAREN FLINT	McLaren Flint-Diabetes Education - Diabetes Education Clinic	G-3230 Beecher Rd	Flint	MI	Terminated
RRC230141-14	Child	RRC	MCLAREN FLINT	Mclaren Family Medicine Residency Group - Family Med Residency Clinic	G-3230 Beecher Rd	Flint	MI	Active
RRC230141-15	Child	RRC	MCLAREN FLINT	Neurologic Rehabilitation Institute - Neurologic Rehabilitation (PT, OT, Speech)	G-3239 Beecher Rd	Flint	MI	Active
RRC230141-16	Child	RRC	MCLAREN FLINT	McLaren Flint Pain Management Clinic - Pain Management Clinic	G-3200 Beecher Rd	Flint	MI	Active
RRC230141-17	Child	RRC	MCLAREN FLINT	Flint Surgical Oncology - Surgical Oncology	4100 Beecher Rd	Flint	MI	Active
RRC230141-18	Child	RRC	MCLAREN FLINT	Mclaren Imaging Center-Flint - Imaging Services	501 S Ballenger Hwy	Flint	MI	Active
RRC230141-19	Child	RRC	MCLAREN FLINT	Grand Blanc Community Medical Center - Primary Care / Internal Medicine	2313 E Hill Rd	Grand Blanc	MI	Active
RRC230141-20	Child	RRC	MCLAREN FLINT	McLaren Bariatric and Metabolic Institute - Bariatric Clinic	G-3200 Beecher Rd	Flint	MI	Active
RRC230141-21	Child	RRC	MCLAREN FLINT	McLaren Sleep Diagnostic Center - Sleep Services	G-3200 Beecher Rd	Flint	MI	Active
RRC230141-22	Child	RRC	MCLAREN FLINT	Mclaren Internal Medicine Residency Group - Internal Med Residency Clinic	G-3230 Beecher Rd	Flint	MI	Active
RRC230141-23	Child	RRC	MCLAREN FLINT	Physical Therapy Flint - Physical Therapy	G-3239 Beecher Rd	Flint	MI	Active
RRC230141-24	Child	RRC	MCLAREN FLINT	McLaren Surgery and Endoscopy Center - ASC (Non-Distinct Part)	501 S Ballenger Hwy	Flint	MI	Active
RRC230141-25	Child	RRC	MCLAREN FLINT	Grand Blanc Occupational Health & Convenient Care - Occupational Health and Convenient Care	2313 E Hill Rd	Grand Blanc	MI	Active
RRC230141-26	Child	RRC	MCLAREN FLINT	Physical Therapy-Davison - Physical Therapy	505 N Dayton St	Davison	MI	Active
RRC230141-27	Child	RRC	MCLAREN FLINT	Partial Hospitalization Psychiatric Program - Behavioral Health Services	4448 Oak Bridge Dr	Flint	MI	Active
RRC230141-28	Child	RRC	MCLAREN FLINT	McLaren Flint Community Medical Center - Primary Care / Internal Medicine/ OB	1314 S Linden Rd	Flint	MI	Active
RRC230141-29	Child	RRC	MCLAREN FLINT	Lab - Fenton - Lab	2420 Owen Rd	Fenton	MI	Active
RRC230141-30	Child	RRC	MCLAREN FLINT	Emergency Department - Fenton - Emergency	2420 Owen Rd	Fenton	MI	Active
RRC230141-31	Child	RRC	MCLAREN FLINT	Medical Imaging Fenton - Radiology	2420 Owen Rd	Fenton	MI	Active
RRC230141-32	Child	RRC	MCLAREN FLINT	McLaren Flint Karmanos Cancer Institute	4100 Beecher Rd	Flint	MI	Active
RRC230141-33	Child	RRC	MCLAREN FLINT	McLaren Flint Infectious Disease - Infectious Disease	G-3200 Beecher Rd	Flint	MI	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/21/2023 9:36:27 AM	8/26/2024 8:33:05 AM	8/26/2024 8:33 AM
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 8:43 AM
Details	Last Recertification Date	Update	Recertification	8/25/2022 8:27:14 AM	8/21/2023 9:36:27 AM	8/21/2023 9:36 AM
Contacts	Primary Contact	Update	PC Change Request	Vandeusen, Kellie Renee Regional Director of Reimbursement McLaren Flint 8103422876	Brown, Sharelle Corporate, 340B Program Director McLaren Health Care 2483968085	1/17/2023 7:03 AM
Details	Last Recertification Date	Update	Recertification	8/31/2021 4:17:17 PM	8/25/2022 8:27:14 AM	8/25/2022 8:27 AM
Details	Last Recertification Date	Update	Recertification		8/31/2021 4:17:17 PM	8/31/2021 4:17 PM
Details	State	Update	OPA Edit	Approved	Active	12/22/2020 9:24 AM
Dates	Start Date	Update	OPA Edit	1/1/2021 12:00:00 AM	12/22/2020 12:00:00 AM	12/22/2020 9:24 AM
Contacts	Signed By	Insert	New Registration		KORTE, FRED CFO McLaren Flint 2483385691	12/22/2020 8:27 AM
Details	340B ID	Update	New Registration		RRC230141-11	12/22/2020 8:27 AM
Details	Entity Subname	Update	New Registration	McLaren Proton Therapy Center	McLaren Proton Therapy Center - Proton Therapy	12/22/2020 8:27 AM
Dates	Participating Approval Date	Update	New Registration		12/22/2020 8:27:51 AM	12/22/2020 8:27 AM
Details	State	Update	New Registration	Pending	Approved	12/22/2020 8:27 AM
Dates	Signed By Date	Update	New Registration		12/21/2020 2:19:37 PM	12/22/2020 8:27 AM
Dates	Start Date	Update	New Registration		1/1/2021 12:00:00 AM	12/22/2020 8:27 AM
Addresses	Main Address	Insert	New Registration		4100 Beecher Rd Flint, MI 48532	12/18/2020 4:18 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1902894512	12/18/2020 4:18 PM
Medicaid Billing	NPI: State	Insert	New Registration		MI	12/18/2020 4:18 PM
Contacts	Authorizing Official	Insert	New Registration		KORTE, FRED CFO McLaren Flint 2483385691	12/18/2020 4:18 PM
Contacts	Primary Contact	Insert	New Registration		Vandeusen, Kellie Renee Regional Director of Reimbursement McLaren Flint 8103422876	12/18/2020 4:18 PM
Details	Assistance Received From Date	Insert	New Registration			12/18/2020 4:18 PM
Details	Assistance Received To Date	Insert	New Registration			12/18/2020 4:18 PM
Details	Last Recertification Date	Insert	New Registration			12/18/2020 4:18 PM
Details	Grant Number	Insert	New Registration			12/18/2020 4:18 PM
Details	340B ID	Insert	New Registration			12/18/2020 4:18 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			12/18/2020 4:18 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			12/18/2020 4:18 PM
Details	Medicare Provider Number	Insert	New Registration		230141	12/18/2020 4:18 PM
Details	Entity Name	Insert	New Registration		MCLAREN FLINT	12/18/2020 4:18 PM
Details	NOFO Number	Insert	New Registration			12/18/2020 4:18 PM
Details	Program Code	Insert	New Registration		RRC	12/18/2020 4:18 PM
Details	Entity Subname	Insert	New Registration		McLaren Proton Therapy Center	12/18/2020 4:18 PM
Dates	Participating Approval Date	Insert	New Registration			12/18/2020 4:18 PM
Details	State	Insert	New Registration		Pending	12/18/2020 4:18 PM
Dates	Registration Date	Insert	New Registration		12/18/2020 4:18:17 PM	12/18/2020 4:18 PM
Dates	Signed By Date	Insert	New Registration			12/18/2020 4:18 PM
Dates	Start Date	Insert	New Registration			12/18/2020 4:18 PM
Terminations	Termination Comments	Insert	New Registration			12/18/2020 4:18 PM
Terminations	Termination Date	Insert	New Registration			12/18/2020 4:18 PM
Terminations	Termination Effective Date	Insert	New Registration			12/18/2020 4:18 PM
Terminations	Termination Reason	Insert	New Registration			12/18/2020 4:18 PM