Covered Entity Details

DSH230230BG EDWARD W SPARROW HOSPITAL ASSOCIATION (Active) - information as of 5/16/2025 11:34:33 PM

Main Details

Name

EDWARD W SPARROW HOSPITAL ASSOCIATION

Subdivision Name

Sparrow Medical Group Holt - Family Practice

Type

Disproportionate Share Hospital

Rural

340B ID

DSH230230BG

Medicare Provider Number

230230

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/13/2021

Participating Start Date

1/1/2022

Participating Approval Date

11/3/2021

Last Recertification Date

8/21/2024

Contacts

Authorizing Official

University of Michigan
Dana Habers, Chief Operating Officer, Pharmacy
(323) 240-3032

Primary Contact

University of Michigan
Cindy Gillespie, Assistant Director, Pharmacy 340B Program
(734) 615-5867

Addresses

Street Address

2040 N Aurelius Road
Suite 22
Holt, MI 48842

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		1073588711

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
DSH230230AA	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	Sparrow Medical Group Senior Health	2909 E Grand River Avenue	Lansing	MI	Terminated
DSH230230AB	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	General Surgery-SLH	1210 W. Saginaw Street	Lansing	MI	Active
DSH230230AC	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	Emergency Department-SLH	1210 W. Saginaw Street	Lansing	MI	Terminated
DSH230230AD	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	SMG Radiology Dewitt	13105 Schavey Road, Ste. 300	Dewitt	MI	Terminated
DSH230230AE	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	OP Mason Rehab Services	800 E. Columbia	Mason	MI	Active
DSH230230AF	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	TCI Arrhy GPB Clinic	405 W. Greenlawn Ste. 400	Lansing	MI	Terminated
DSH230230AG	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	Sparrow Urgent Care Grand Ledge	1015 Charlevoix Drive	Grand Ledge	MI	Active
DSH230230AH	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	Sparrow TCI Owosso	300 Health Park Drive	Owosso	MI	Active
DSH230230AK	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	Sparrow Hospice House of MidMichigan	1210 W. Saginaw Street	Lansing	MI	Active
DSH230230AL	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	Sparrow Medical Oncology	1140 East Michigan Avenue	LANSING	MI	Active
DSH230230AM	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	Sparrow Medical Group Bariatrics	2900 HANNAH Boulevard	EAST LANSING	MI	Active
DSH230230AN	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	SPARROW HEALTH CENTER ENDOSCOPY	2909 E GRAND RIVER AVENUE	LANSING	MI	Active
DSH230230AP	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	Sparrow Urgent Care Lansing	1120 E MICHIGAN AVE	LANSING	MI	Active
DSH230230AQ	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	Sparrow Medical Group Mason - Family Practice	230 Temple Street	Mason	MI	Active
DSH230230AR	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	Sparrow Medical Group Lansing - Family Practice	1200 East Michigan Avenue	Lansing	MI	Active
DSH230230AS	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	Sparrow Medical Group Nephrology - Nephrology	1200 E Michigan Avenue	Lansing	MI	Active
DSH230230AT	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	Sparrow Medical Group - Lansing OB/GYN	1200 E Michigan Avenue	Lansing	MI	Active
DSH230230AU	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	Sparrow Medical Group West - Family Practice	7335 Westshire Drive	Lansing	MI	Active
DSH230230AV	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	Sparrow Medical Group DeWitt - Family Practice	13191 Schavey Road	DeWitt	MI	Active
DSH230230AW	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	Sparrow Sports Medicine/HSP Sports Medicine - Sports Medicine	2900 Hannah Blvd	East Lansing	MI	Active
DSH230230AX	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	Sparrow Medical Group OB/GYN - OB/GYN	1651 W Lake Lansing Road	East Lansing	MI	Active
DSH230230AY	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	Sparrow Cardiovascular Surgery - General Surgery	1140 E Michigan Avenue	Lansing	MI	Active
DSH230230AZ	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	Sparrow Medical Group - East Lansing	2900 Hannah Blvd	East Lansing	MI	Active
DSH230230BA	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	Sparrow Medical Group Urology - Family Practice	1140 E Michigan Avenue	Lansing	MI	Active
DSH230230BB	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	Sparrow Medical Group Williamston - Family Practice	301 Williamston Center Road	Williamston	MI	Active
DSH230230BC	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	Sparrow Medical Group Okemos - Family Practice	1600 W Grand River Avenue	Okemos	MI	Active
DSH230230BD	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	Sparrow Medical Group North - Family Practice	2909 E Grand River Avenue	Lansing	MI	Active
DSH230230BE	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	Sparrow Family Medicine Residency - Mason	800 E Columbia Street	Mason	MI	Active
DSH230230BF	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	Sparrow Medical Group General Surgery - General Surgery	1200 E Michigan Avenue	Lansing	MI	Active
DSH230230BG	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	Sparrow Medical Group Holt - Family Practice	2040 N Aurelius Road	Holt	MI	Active
DSH230230BH	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	Sparrow Home Hospice - Hospice	1210 W Saginaw Street	Lansing	MI	Active
DSH230230BJ	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	Sparrow Medical Group Lansing Internal Medicine - Family Practice	1200 E Michigan Avenue	Lansing	MI	Active
DSH230230BK	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	Sparrow Women’s Health - Family Practice	1200 E Michigan Avenue	Lansing	MI	Active
DSH230230BL	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	Sparrow Medical Group Eastside - Family Practice	2909 E Grand River Avenue	Lansing	MI	Active
DSH230230BM	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	Sparrow Medical Group Orthopedics & Sports Medicine - Sports Medicine	4660 South Hagadorn	East Lansing	MI	Active
DSH230230BN	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	Sparrow Medical Group Family Medicine Residency Central - Family Practice	1200 E Michigan Ave	Lansing	MI	Active
DSH230230BP	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	Sparrow Medical Group Lansing OB/GYN - Okemos - OB/GYN	1600 W Grand River Ave	Okemos	MI	Active
DSH230230BQ	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	Sparrow Medical Group OB/GYN St Johns - OB/GYN	901 S Oakland St	St Johns	MI	Active
DSH230230BS	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	Sparrow Medical Group Orthopedics & Sports Medicine - Jolly Rd - Sports Medicine	3394 E Jolly Rd	Lansing	MI	Active
DSH230230BT	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	Sparrow Medical Group Maternal Fetal Medicine - Fetal Medicine	1200 E Michigan Ave	Lansing	MI	Active
DSH230230BU	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	Sparrow Medical Group Gynecologic Oncology - Gynecology	1200 E Michigan Ave	Lansing	MI	Active
DSH230230BV	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	Sparrow TCI Williamston - Cardiology	301 Williamston Center Road	Williamston	MI	Active
DSH230230BW	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	Sparrow Medical Group Internal Medicine Residency - Internal Medicine	1200 E Michigan Avenue	Lansing	MI	Active
DSH230230BX	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	Sparrow Medical Group Owosso Internal Medicine - Internal Medicine Outpatient	1457 M-54	Owosso	MI	Terminated
DSH230230BY	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	Sparrow Medical Group Okemos Jolly Rd - Family Practice	2446 Jolly Road	Okemos	MI	Active
DSH230230BZ	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	Sparrow Emergency Center Okemos - Emergency Room	2446 Jolly Road	Okemos	MI	Active
DSH230230CA	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	Sparrow TCI Clinton - Cardiology	901 S Oakland St	St Johns	MI	Active
DSH230230CB	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	Sparrow Medical Group Nephrology - St Johns - Nephrology	901 S Oakland St	St Johns	MI	Active
DSH230230CC	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	Sparrow Medical Group Urology - St Johns - Urology	901 S Oakland St	St Johns	MI	Active
DSH230230CD	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	Behavioral Health - Behavioral Health	1210 W Saginaw St	Lansing	MI	Active
DSH230230CE	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	Sparrow TCI Eaton - Cardiology	321 E Harris St	Charlotte	MI	Active
DSH230230CF	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	palliative & Support Care - Support Care	1140 E Michigan Ave	Lansing	MI	Active
DSH230230CG	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	Sparrow Medical Group Pulmonology - Pulmonology	1200 E Michigan Avenue	Lansing	MI	Active
DSH230230CH	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	University of Michigan Health - Sparrow Mason Orthopedic (117139) - Orthopedic	800 E Columbia St	Mason	MI	Active
DSH230230CJ	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	University of Michigan Health-Sparrow Carson Heart & Vascular (117753) - Heart and Vascular	245 S 2nd St.	Carson City	MI	Active
DSH230230CK	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	University Of Michigan Health-Sparrow Lansing Gastroenterology (7141) - Gastro	2909 E Grand River Avenue	Lansing	MI	Active
DSH230230CL	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	University of Michigan Health-Sparrow Ionia Pain Management Center - Pain Management	205 S Dexter St	Ionia	MI	Terminated
DSH230230D	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	Sparrow Urgent Care East Lansing	2682 E. Grand River Avenue	East Lansing	MI	Active
DSH230230E	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	OP Rehab-Dewitt	13105 Schavey Road, Ste. 300	Dewitt	MI	Terminated
DSH230230F	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	OP Rehab-Williamston	1288 W. Grand River Avenue	Williamston	MI	Active
DSH230230G	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	OP Rehab-Health Sciences Pavillion	2900 Hannah Blvd, Ste. B102	East Lansing	MI	Active
DSH230230H	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	OP Grand Ledge Rehab Services	1015 Charlevoix Drive	Grand Ledge	MI	Active
DSH230230J	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	Okemos Diagnostic Center	1600 E. Grand River Avenue	Okemos	MI	Active
DSH230230K	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	Ramblewood Imaging Center	2909 East Grand River	Lansing	MI	Terminated
DSH230230L	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	Sparrow Health Center - Radiology	2909 E Grand River Avenue	Lansing	MI	Active
DSH230230M	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	Sparrow Medical Group - West - Radiology	7335 Westshire Drive	Lansing	MI	Active
DSH230230N	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	Sparrow Urgent Care Mason	800 E. Columbia St.	Mason	MI	Active
DSH230230P	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	Sparrow Occupational Health	1322 E. Michigan Ave,	Lansing	MI	Active
DSH230230Q	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	TCI Cardiology GPB Diagnostic	405 W. Greenlawn, Ste. 400	Lansing	MI	Terminated
DSH230230R	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	Sparrow Infusion Center	1140 E Michigan Avenue	Lansing	MI	Active
DSH230230S	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	Sparrow Pain Management Center	1200 E. Michigan Avenue	Lansing	MI	Active
DSH230230T	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	Pediatric Subspecialty Clinic	1200 E. Michigan Avenue	Lansing	MI	Active
DSH230230U	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	OP Hospital Rehab Services	1200 E. Michigan Avenue	Lansing	MI	Active
DSH230230V	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	SPB Diagnostic Imaging	1200 E. Michigan Avenue	Lansing	MI	Active
DSH230230W	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	TCI Cardiology SPB Diagnostics	1200 E. Michigan Avenue	Lansing	MI	Terminated
DSH230230X	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	Sparrow TCI	1140 E Michigan Avenue	Lansing	MI	Active
DSH230230Y	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	Sparrow Diabetes and Endocrinology Services	2900 Hannah Boulevard	East Lansing	MI	Active
DSH230230Z	Child	DSH	EDWARD W SPARROW HOSPITAL ASSOCIATION	Sparrow Wound and Hyperbaric Clinic	1210 W. Saginaw St	Lansing	MI	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Profile Change Request	Habers, Dana Chief Operating Officer, Pharmacy University of Michigan 7349364338	Habers, Dana Chief Operating Officer, Pharmacy University of Michigan 3232403032	5/12/2025 10:14 AM
Contacts	Primary Contact	Update	Group Change Request	Lee, Janine M Clinical Pharmacist, 340B Program University of Michigan 7349368210	Gillespie, Cindy Assistant Director, Pharmacy 340B Program University of Michigan 7346155867	2/12/2025 11:09 AM
Contacts	Authorizing Official	Update	Change Request	Miller, David President University of Michigan Health Systems University of Michigan Hospitals and Health Centers 7346476313	Habers, Dana Chief Operating Officer, Pharmacy University of Michigan 7349364338	12/17/2024 12:10 PM
Contacts	Primary Contact	Update	Profile Change Request	Lee, Janine M Assistant Direct 340B Program University of Michigan 7349368210	Lee, Janine M Clinical Pharmacist, 340B Program University of Michigan 7349368210	8/22/2024 9:55 AM
Details	Last Recertification Date	Update	Recertification	8/18/2023 3:57:11 PM	8/21/2024 11:54:07 AM	8/21/2024 11:54 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	230230 (MI)		7/22/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1437400413 (MI)		7/22/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1033162326 (MI)		7/22/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1033513148 (MI)		7/22/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1043264559 (MI)		7/22/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1043562465 (MI)		7/22/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1083668545 (MI)		7/22/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1083982748 (MI)		7/22/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1124502851 (MI)		7/22/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1205285335 (MI)		7/22/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1245737402 (MI)		7/22/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1427004183 (MI)		7/22/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1437102357 (MI)		7/22/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1437331501 (MI)		7/22/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1457744666 (MI)		7/22/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1477509313 (MI)		7/22/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1487154290 (MI)		7/22/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1508812264 (MI)		7/22/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1568867190 (MI)		7/22/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1578503603 (MI)		7/22/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1619569126 (MI)		7/22/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1700365244 (MI)		7/22/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1710580949 (MI)		7/22/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1740233717 (MI)		7/22/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1811943582 (MI)		7/22/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1821041013 (MI)		7/22/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1831139088 (MI)		7/22/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1942256607 (MI)		7/22/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1629517420 (MI)		7/22/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1366498107 (MI)		7/22/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1811942436 (MI)		7/22/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1033165790 (MI)		7/22/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1841665247 (MI)		7/22/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1205213014 (MI)		7/22/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1538596440 (MI)		7/22/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1295788404 (MI)		7/22/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1124654793 (MI)		7/22/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1437341195 (MI)		7/22/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1164478822 (MI)		7/22/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1407494768 (MI)		7/22/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1689620098 (MI)		7/22/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1699168849 (MI)		7/22/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1730360835 (MI)		7/22/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1568801611 (MI)		7/22/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1720034499 (MI)		7/22/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1285949461 (MI)		7/22/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1023659802 (MI)		7/22/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1174562649 (MI)		7/22/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1902852676 (MI)		7/22/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1245822386 (MI)		7/22/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1598145997 (MI)		7/22/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1568046209 (MI)		7/22/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1093150781 (MI)		7/22/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1760065825 (MI)		7/22/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1669431292 (MI)		7/22/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1477512424 (MI)		7/22/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1053424820 (MI)		7/22/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1871606640 (MI)		7/22/2024 11:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1619089539 (MI)		7/22/2024 11:02 AM
Contacts	Primary Contact	Update	Change Request	Belding, Todd M Director of Pharmacy Sparrow Health System Sparrow 5172532376	Lee, Janine M Assistant Direct 340B Program University of Michigan 7349368210	7/22/2024 11:02 AM
Contacts	Authorizing Official	Update	Change Request	Howe, William SHS-VP Chief Financial Officer Sparrow Hospital Sparrow 5172536102	Miller, David President University of Michigan Health Systems University of Michigan Hospitals and Health Centers 7346476313	2/26/2024 2:08 PM
Details	Last Recertification Date	Update	Recertification	9/12/2022 12:13:02 PM	8/18/2023 3:57:11 PM	8/18/2023 3:57 PM
Addresses	Main Address	Update	Recertification	2040 Aurelius Rd Suite 22 Holt, MI 48842	2040 N Aurelius Road Suite 22 Holt, MI 48842	9/12/2022 12:13 PM
Details	Last Recertification Date	Update	Recertification		9/12/2022 12:13:02 PM	9/12/2022 12:13 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1033162326	1/19/2022 6:52 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	1/19/2022 6:52 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1033513148	1/19/2022 6:52 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	1/19/2022 6:52 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1043264559	1/19/2022 6:52 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	1/19/2022 6:52 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1043562465	1/19/2022 6:52 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	1/19/2022 6:52 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1073588711	1/19/2022 6:52 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	1/19/2022 6:52 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1083668545	1/19/2022 6:52 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	1/19/2022 6:52 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1083982748	1/19/2022 6:52 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	1/19/2022 6:52 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1124502851	1/19/2022 6:52 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	1/19/2022 6:52 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1205285335	1/19/2022 6:52 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	1/19/2022 6:52 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1245737402	1/19/2022 6:52 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	1/19/2022 6:52 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1427004183	1/19/2022 6:52 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	1/19/2022 6:52 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1437102357	1/19/2022 6:52 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	1/19/2022 6:52 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1437331501	1/19/2022 6:52 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	1/19/2022 6:52 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1457744666	1/19/2022 6:52 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	1/19/2022 6:52 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1477509313	1/19/2022 6:52 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	1/19/2022 6:52 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1487154290	1/19/2022 6:52 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	1/19/2022 6:52 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1508812264	1/19/2022 6:52 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	1/19/2022 6:52 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1568867190	1/19/2022 6:52 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	1/19/2022 6:52 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1578503603	1/19/2022 6:52 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	1/19/2022 6:52 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1619569126	1/19/2022 6:52 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	1/19/2022 6:52 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1700365244	1/19/2022 6:52 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	1/19/2022 6:52 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1710580949	1/19/2022 6:52 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	1/19/2022 6:52 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1740233717	1/19/2022 6:52 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	1/19/2022 6:52 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1811943582	1/19/2022 6:52 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	1/19/2022 6:52 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1821041013	1/19/2022 6:52 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	1/19/2022 6:52 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1831139088	1/19/2022 6:52 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	1/19/2022 6:52 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1942256607	1/19/2022 6:52 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	1/19/2022 6:52 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1629517420	1/19/2022 6:52 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	1/19/2022 6:52 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1366498107	1/19/2022 6:52 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	1/19/2022 6:52 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1811942436	1/19/2022 6:52 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	1/19/2022 6:52 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1033165790	1/19/2022 6:52 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	1/19/2022 6:52 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1841665247	1/19/2022 6:52 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	1/19/2022 6:52 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1205213014	1/19/2022 6:52 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	1/19/2022 6:52 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1538596440	1/19/2022 6:52 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	1/19/2022 6:52 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1295788404	1/19/2022 6:52 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	1/19/2022 6:52 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1124654793	1/19/2022 6:52 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	1/19/2022 6:52 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1437341195	1/19/2022 6:52 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	1/19/2022 6:52 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1164478822	1/19/2022 6:52 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	1/19/2022 6:52 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1407494768	1/19/2022 6:52 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	1/19/2022 6:52 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1689620098	1/19/2022 6:52 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	1/19/2022 6:52 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1699168849	1/19/2022 6:52 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	1/19/2022 6:52 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1730360835	1/19/2022 6:52 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	1/19/2022 6:52 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1568801611	1/19/2022 6:52 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	1/19/2022 6:52 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1720034499	1/19/2022 6:52 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	1/19/2022 6:52 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1285949461	1/19/2022 6:52 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	1/19/2022 6:52 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1023659802	1/19/2022 6:52 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	1/19/2022 6:52 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1174562649	1/19/2022 6:52 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	1/19/2022 6:52 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1902852676	1/19/2022 6:52 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	1/19/2022 6:52 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1245822386	1/19/2022 6:52 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	1/19/2022 6:52 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1598145997	1/19/2022 6:52 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	1/19/2022 6:52 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1568046209	1/19/2022 6:52 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	1/19/2022 6:52 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1093150781	1/19/2022 6:52 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	1/19/2022 6:52 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1760065825	1/19/2022 6:52 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	1/19/2022 6:52 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1669431292	1/19/2022 6:52 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	1/19/2022 6:52 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1477512424	1/19/2022 6:52 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	1/19/2022 6:52 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1053424820	1/19/2022 6:52 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	1/19/2022 6:52 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1871606640	1/19/2022 6:52 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	1/19/2022 6:52 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1619089539	1/19/2022 6:52 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	1/19/2022 6:52 PM
Details	State	Update		Approved	Active	1/1/2022 12:01 AM
Contacts	Signed By	Insert	New Registration		Howe, William SHS-VP Chief Financial Officer Sparrow Hospital Sparrow 5172536102	11/3/2021 7:46 AM
Details	340B ID	Update	New Registration		DSH230230BG	11/3/2021 7:46 AM
Details	Entity Name	Update	New Registration	EDWARD W. SPARROW HOSPITAL	EDWARD W SPARROW HOSPITAL ASSOCIATION	11/3/2021 7:46 AM
Details	Entity Subname	Update	New Registration	Sparrow Medical Group Holt	Sparrow Medical Group Holt - Family Practice	11/3/2021 7:46 AM
Dates	Participating Approval Date	Update	New Registration		11/3/2021 7:46:09 AM	11/3/2021 7:46 AM
Details	State	Update	New Registration	Pending	Approved	11/3/2021 7:46 AM
Dates	Signed By Date	Update	New Registration		10/26/2021 8:08:27 AM	11/3/2021 7:46 AM
Dates	Start Date	Update	New Registration		1/1/2022 12:00:00 AM	11/3/2021 7:46 AM
Addresses	Main Address	Insert	New Registration		2040 Aurelius Rd Suite 22 Holt, MI 48842	10/13/2021 12:03 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/13/2021 12:03 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		230230	10/13/2021 12:03 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		MI	10/13/2021 12:03 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1437400413	10/13/2021 12:03 PM
Medicaid Billing	NPI: State	Insert	New Registration		MI	10/13/2021 12:03 PM
Contacts	Primary Contact	Insert	New Registration		Belding, Todd M Director of Pharmacy Sparrow Health System Sparrow 5172532376	10/13/2021 12:03 PM
Contacts	Authorizing Official	Insert	New Registration		Howe, William SHS-VP Chief Financial Officer Sparrow Hospital Sparrow 5172536102	10/13/2021 12:03 PM
Details	Assistance Received From Date	Insert	New Registration			10/13/2021 12:03 PM
Details	Assistance Received To Date	Insert	New Registration			10/13/2021 12:03 PM
Details	Last Recertification Date	Insert	New Registration			10/13/2021 12:03 PM
Details	Grant Number	Insert	New Registration			10/13/2021 12:03 PM
Details	340B ID	Insert	New Registration			10/13/2021 12:03 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/13/2021 12:03 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/13/2021 12:03 PM
Details	Medicare Provider Number	Insert	New Registration		230230	10/13/2021 12:03 PM
Details	Entity Name	Insert	New Registration		EDWARD W. SPARROW HOSPITAL	10/13/2021 12:03 PM
Details	NOFO Number	Insert	New Registration			10/13/2021 12:03 PM
Details	Program Code	Insert	New Registration		DSH	10/13/2021 12:03 PM
Details	Entity Subname	Insert	New Registration		Sparrow Medical Group Holt	10/13/2021 12:03 PM
Dates	Participating Approval Date	Insert	New Registration			10/13/2021 12:03 PM
Details	State	Insert	New Registration		Pending	10/13/2021 12:03 PM
Dates	Registration Date	Insert	New Registration		10/13/2021 12:03:53 PM	10/13/2021 12:03 PM
Dates	Signed By Date	Insert	New Registration			10/13/2021 12:03 PM
Dates	Start Date	Insert	New Registration			10/13/2021 12:03 PM
Terminations	Termination Comments	Insert	New Registration			10/13/2021 12:03 PM
Terminations	Termination Date	Insert	New Registration			10/13/2021 12:03 PM
Terminations	Termination Effective Date	Insert	New Registration			10/13/2021 12:03 PM
Terminations	Termination Reason	Insert	New Registration			10/13/2021 12:03 PM