| Contacts | Authorizing Official | Update | AO Change Request | erickson, michael joseph
President
MidMichigan Medical Center - Alpena
9898393378 | Nostrant, Hunter
President
MyMichigan Medical Center Alpena
9893567245 | 11/6/2024 8:21 AM |
| Details | Last Recertification Date | Update | Recertification | 8/28/2023 10:19:35 AM | 8/16/2024 1:46:39 PM | 8/16/2024 1:46 PM |
| Contacts | Primary Contact | Update | Profile Change Request | Waibel, Lisa
340B Supervisor
MyMichigan Health
9897945231 | Waibel, Lisa
340B Manager
MyMichigan Health
9897945231 | 7/23/2024 3:55 PM |
| Addresses | Main Address | Update | Change Request |
4201 CAMPUS RIDGE DRIVE
MIDLAND, MI 48670-6123 |
4201 CAMPUS RIDGE DRIVE
Suite 2200
MIDLAND, MI 48670-6123 | 6/5/2024 1:42 PM |
| Addresses | Main Address | Update | Change Request |
4500 CAMPUS RIDGE DR
MIDLAND, MI 48640-6123 |
4201 CAMPUS RIDGE DRIVE
MIDLAND, MI 48670-6123 | 1/9/2024 8:52 AM |
| Details | Last Recertification Date | Update | Recertification | 8/29/2022 9:16:51 AM | 8/28/2023 10:19:35 AM | 8/28/2023 10:19 AM |
| Contacts | Signed By | Update | Profile Change Request | Sherwin, Chuck
President
MidMichigan Medical Center - Alpena
9893567779 | Sherwin, Chuck
President
MyMichigan Medical Center Midland
9897947625 | 6/7/2023 6:50 AM |
| Contacts | Primary Contact | Update | Profile Change Request | Waibel, Lisa
340B Supervisor
MyMichigan Health
9895450567 | Waibel, Lisa
340B Supervisor
MyMichigan Health
9897945231 | 6/6/2023 2:44 PM |
| Details | Entity Name | Update | Change Request | MIDMICHIGAN MEDICAL CENTER - ALPENA | MyMichigan Medical Center Alpena | 6/5/2023 7:54 AM |
| Contacts | Primary Contact | Update | Group Change Request | Bruhnsen, Kayla
340B Program Coordinator
MidMichigan Medical Center
9894885799 | Waibel, Lisa
340B Supervisor
MyMichigan Health
9895450567 | 3/21/2023 10:26 AM |
| Contacts | Primary Contact | Update | Group Change Request | Balcer, Alicia
340B Program Coordinator
MidMichigan Medical Center
9898025107 | Bruhnsen, Kayla
340B Program Coordinator
MidMichigan Medical Center
9894885799 | 1/4/2023 7:54 AM |
| Details | Last Recertification Date | Update | Recertification | | 8/29/2022 9:16:51 AM | 8/29/2022 9:16 AM |
| Contacts | Authorizing Official | Update | Change Request | Sherwin, Chuck
President
MidMichigan Medical Center - Alpena
9893567779 | erickson, michael joseph
President
MidMichigan Medical Center - Alpena
9898393378 | 7/12/2022 8:42 AM |
| Contacts | Primary Contact | Update | PC Change Request | Waibel, Lisa
340B Program Coordinator
MidMichigan Medical Center
9894885799 | Balcer, Alicia
340B Program Coordinator
MidMichigan Medical Center
9898025107 | 6/17/2022 7:35 AM |
| Details | State | Update | | Approved | Active | 1/1/2022 12:01 AM |
| Contacts | Signed By | Insert | New Registration | | Sherwin, Chuck
President
MidMichigan Medical Center - Alpena
9893567779 | 11/8/2021 6:24 AM |
| Details | 340B ID | Update | New Registration | | DSH230036B | 11/8/2021 6:24 AM |
| Details | Entity Subname | Update | New Registration | MIDMICHIGAN MEDICAL CENTER - ALPENA | MIDMICHIGAN MEDICAL CENTER - ALPENA - Infusion Center - Midland | 11/8/2021 6:24 AM |
| Dates | Participating Approval Date | Update | New Registration | | 11/8/2021 6:24:10 AM | 11/8/2021 6:24 AM |
| Details | State | Update | New Registration | Pending | Approved | 11/8/2021 6:24 AM |
| Dates | Signed By Date | Update | New Registration | | 10/11/2021 2:40:29 PM | 11/8/2021 6:24 AM |
| Dates | Start Date | Update | New Registration | | 1/1/2022 12:00:00 AM | 11/8/2021 6:24 AM |
| Addresses | Main Address | Insert | New Registration | |
4500 CAMPUS RIDGE DR
MIDLAND, MI 48640-6123 | 10/7/2021 11:47 AM |
| Contacts | Authorizing Official | Insert | New Registration | | Sherwin, Chuck
President
MidMichigan Medical Center - Alpena
9893567779 | 10/7/2021 11:47 AM |
| Contacts | Primary Contact | Insert | New Registration | | Waibel, Lisa
340B Program Coordinator
MidMichigan Medical Center
9894885799 | 10/7/2021 11:47 AM |
| Details | Assistance Received From Date | Insert | New Registration | | | 10/7/2021 11:47 AM |
| Details | Assistance Received To Date | Insert | New Registration | | | 10/7/2021 11:47 AM |
| Details | Last Recertification Date | Insert | New Registration | | | 10/7/2021 11:47 AM |
| Details | Grant Number | Insert | New Registration | | | 10/7/2021 11:47 AM |
| Details | 340B ID | Insert | New Registration | | | 10/7/2021 11:47 AM |
| Details | Is Authorizing Official EHB Data | Insert | New Registration | | | 10/7/2021 11:47 AM |
| Dates | Last Date That 340B Drugs Purchased | Insert | New Registration | | | 10/7/2021 11:47 AM |
| Details | Medicare Provider Number | Insert | New Registration | | 230036 | 10/7/2021 11:47 AM |
| Details | Entity Name | Insert | New Registration | | MIDMICHIGAN MEDICAL CENTER - ALPENA | 10/7/2021 11:47 AM |
| Details | NOFO Number | Insert | New Registration | | | 10/7/2021 11:47 AM |
| Details | Program Code | Insert | New Registration | | DSH | 10/7/2021 11:47 AM |
| Details | Entity Subname | Insert | New Registration | | MIDMICHIGAN MEDICAL CENTER - ALPENA | 10/7/2021 11:47 AM |
| Dates | Participating Approval Date | Insert | New Registration | | | 10/7/2021 11:47 AM |
| Details | State | Insert | New Registration | | Pending | 10/7/2021 11:47 AM |
| Dates | Registration Date | Insert | New Registration | | 10/7/2021 11:47:46 AM | 10/7/2021 11:47 AM |
| Dates | Signed By Date | Insert | New Registration | | | 10/7/2021 11:47 AM |
| Dates | Start Date | Insert | New Registration | | | 10/7/2021 11:47 AM |
| Terminations | Termination Comments | Insert | New Registration | | | 10/7/2021 11:47 AM |
| Terminations | Termination Date | Insert | New Registration | | | 10/7/2021 11:47 AM |
| Terminations | Termination Effective Date | Insert | New Registration | | | 10/7/2021 11:47 AM |
| Terminations | Termination Reason | Insert | New Registration | | | 10/7/2021 11:47 AM |