Covered Entity Details

RRC230037-04 Hillsdale Community Health Center (Active) - information as of 5/30/2025 6:54:26 PM

Main Details

Name

Hillsdale Community Health Center

Subdivision Name

HILLSDALE HEALTH AND WELLNESS - Hillsdale Health and Wellness GENERAL MEDICINE

Type

Rural Referral Center

Rural

Yes

340B ID

RRC230037-04

Medicare Provider Number

230037

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/7/2022

Participating Start Date

4/1/2022

Participating Approval Date

2/1/2022

Last Recertification Date

8/26/2024

Contacts

Authorizing Official

Hillsdale Hospital
Mark Gross, CFO
(517) 437-5232

Primary Contact

Hillsdale Hospital
Jeff Kauffman, Director of Pharmacy
(517) 437-5239

Addresses

Street Address

240 W CARLETON
HILLSDALE, MI 49242

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?
No

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
RRC230037-01	Child	RRC	Hillsdale Community Health Center	HCHC Infusion Center	451 Hidden Meadows Drive	Hillsdale	MI	Terminated
RRC230037-02	Child	RRC	Hillsdale Community Health Center	HILLSDALE COMNUNITY HEALTH CENTER - Reading Health Clinic	143 S MAIN ST	READING	MI	Active
RRC230037-03	Child	RRC	Hillsdale Community Health Center	LITCHFIELD CLINIC - LITCHFIELD CLINIC GENERAL MEDICINE	535 MARSHALL ST	LITCHFIELD	MI	Terminated
RRC230037-04	Child	RRC	Hillsdale Community Health Center	HILLSDALE HEALTH AND WELLNESS - Hillsdale Health and Wellness GENERAL MEDICINE	240 W CARLETON	HILLSDALE	MI	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/21/2023 7:16:31 AM	8/26/2024 7:14:31 AM	8/26/2024 7:14 AM
Details	Last Recertification Date	Update	Recertification	8/24/2022 9:28:24 AM	8/21/2023 7:16:31 AM	8/21/2023 7:16 AM
Details	Last Recertification Date	Update	Recertification		8/24/2022 9:28:24 AM	8/24/2022 9:28 AM
Details	State	Update		Approved	Active	4/1/2022 12:01 AM
Contacts	Signed By	Insert	New Registration		Gross, Mark CFO Hillsdale Hospital 5174375232	2/1/2022 12:56 PM
Details	340B ID	Update	New Registration		RRC230037-04	2/1/2022 12:56 PM
Details	Entity Name	Update	New Registration	HILLSDALE HOSPITAL	Hillsdale Community Health Center	2/1/2022 12:56 PM
Details	Entity Subname	Update	New Registration	HILLSDALE HEALTH AND WELLNESS	HILLSDALE HEALTH AND WELLNESS - Hillsdale Health and Wellness GENERAL MEDICINE	2/1/2022 12:56 PM
Dates	Participating Approval Date	Update	New Registration		2/1/2022 12:56:39 PM	2/1/2022 12:56 PM
Details	State	Update	New Registration	Pending	Approved	2/1/2022 12:56 PM
Dates	Signed By Date	Update	New Registration		1/26/2022 12:09:59 PM	2/1/2022 12:56 PM
Dates	Start Date	Update	New Registration		4/1/2022 12:00:00 AM	2/1/2022 12:56 PM
Addresses	Main Address	Insert	New Registration		240 W CARLETON HILLSDALE, MI 49242	1/7/2022 2:08 PM
Contacts	Authorizing Official	Insert	New Registration		Gross, Mark CFO Hillsdale Hospital 5174375232	1/7/2022 2:08 PM
Contacts	Primary Contact	Insert	New Registration		Kauffman, Jeff Director of Pharmacy Hillsdale Hospital 5174375239	1/7/2022 2:08 PM
Details	Assistance Received From Date	Insert	New Registration			1/7/2022 2:08 PM
Details	Assistance Received To Date	Insert	New Registration			1/7/2022 2:08 PM
Details	Last Recertification Date	Insert	New Registration			1/7/2022 2:08 PM
Details	Grant Number	Insert	New Registration			1/7/2022 2:08 PM
Details	340B ID	Insert	New Registration			1/7/2022 2:08 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/7/2022 2:08 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/7/2022 2:08 PM
Details	Medicare Provider Number	Insert	New Registration		230037	1/7/2022 2:08 PM
Details	Entity Name	Insert	New Registration		HILLSDALE HOSPITAL	1/7/2022 2:08 PM
Details	NOFO Number	Insert	New Registration			1/7/2022 2:08 PM
Details	Program Code	Insert	New Registration		RRC	1/7/2022 2:08 PM
Details	Entity Subname	Insert	New Registration		HILLSDALE HEALTH AND WELLNESS	1/7/2022 2:08 PM
Dates	Participating Approval Date	Insert	New Registration			1/7/2022 2:08 PM
Details	State	Insert	New Registration		Pending	1/7/2022 2:08 PM
Dates	Registration Date	Insert	New Registration		1/7/2022 2:08:50 PM	1/7/2022 2:08 PM
Dates	Signed By Date	Insert	New Registration			1/7/2022 2:08 PM
Dates	Start Date	Insert	New Registration			1/7/2022 2:08 PM
Terminations	Termination Comments	Insert	New Registration			1/7/2022 2:08 PM
Terminations	Termination Date	Insert	New Registration			1/7/2022 2:08 PM
Terminations	Termination Effective Date	Insert	New Registration			1/7/2022 2:08 PM
Terminations	Termination Reason	Insert	New Registration			1/7/2022 2:08 PM