Covered Entity Details

DSH230236Y METROPOLITAN HOSPITAL (Active) - information as of 5/26/2025 12:58:26 AM

Main Details

Name

METROPOLITAN HOSPITAL

Subdivision Name

UNIVERSITY OF MICHIGAN HEALTH-WEST - RHEUMATOLOGY / INFUSION CENTER - SUITE 106 - RHEUMATOLOGY / INFUSION CENTER

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH230236Y

Medicare Provider Number

230236

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

4/15/2022

Participating Start Date

7/1/2022

Participating Approval Date

4/20/2022

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

4055 CASCADE ROAD SE
SUITE 106
GRAND RAPIDS, MI 49546

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

Shipping Address 1

UNIVERSITY OF MICHIGAN HEALTH-WEST PARK EAST PHARMACY
4055 CASCADE ROAD SE
Grand Rapids, MI 49546

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
DSH230236A	Child	DSH	METROPOLITAN HOSPITAL	UMH-WEST - CANCER CENTER	5950 METRO WAY	WYOMING	MI	Active
DSH230236AA	Child	DSH	METROPOLITAN HOSPITAL	UMH-W - SOUTHWEST - DIABETIC EDUCATION (80550) - DIABETES CARE	2215 44TH STREET SW	WYOMING	MI	Active
DSH230236AB	Child	DSH	METROPOLITAN HOSPITAL	UMH-W - EAST CAMPUS - PULMONOLOGY (94500) - SPECIALTY CARE - PULM - EAST CAMPUS	(PE) 4055 CASCADE ROAD SE	GRAND RAPIDS	MI	Active
DSH230236AC	Child	DSH	METROPOLITAN HOSPITAL	UMH-W - THORACIC SURGERY (94600) - THORACIC SURGERY	(PB) 2122 HEALTH DRIVE SW	WYOMING	MI	Active
DSH230236AD	Child	DSH	METROPOLITAN HOSPITAL	UMH-W INFECTIOUS DISEASE (94300) - SPECIALTY CARE - ID	(PB) 2122 HEALTH DRIVE SW	WYOMING	MI	Active
DSH230236AE	Child	DSH	METROPOLITAN HOSPITAL	UMH-W - EAST CAMPUS - PODIATRY (91750) - SPECIALTY CARE - PODIATRY	(PE) 4055 CASCADE ROAD SE	GRAND RAPIDS	MI	Active
DSH230236AF	Child	DSH	METROPOLITAN HOSPITAL	UMH-WEST - WOUND CLINIC (71210) - WOUND CARE	(PB) 2122 HEALTH DRIVE SW	WYOMING	MI	Active
DSH230236AG	Child	DSH	METROPOLITAN HOSPITAL	UMH-W - EXECUTIVE HEALTH (83820) - PATIENT CARE	(PB) 2122 Health Drive SW	WYOMING	MI	Active
DSH230236AH	Child	DSH	METROPOLITAN HOSPITAL	UMH West East Campus Diabetic Edu (80550) - Diabetic Education	4055 Cascade Road SE	Grand Rapids	MI	Active
DSH230236AJ	Child	DSH	METROPOLITAN HOSPITAL	UMH West Healthpark ENT - Ears, Nose, Throat	2093 Health Dr SW	Wyoming	MI	Active
DSH230236AK	Child	DSH	METROPOLITAN HOSPITAL	UMH West Southwest Podiatry (91750) - Podiatry	2215 44th SW	Wyoming	MI	Active
DSH230236AL	Child	DSH	METROPOLITAN HOSPITAL	UMH West Wayland Pulmonology (94500) - Pulmonology	1113 W. Superior St	Wayland	MI	Active
DSH230236AM	Child	DSH	METROPOLITAN HOSPITAL	UMH West Park East Gastro (94200) - Gastro	4055 Cascade Rd SE	Grand Rapids	MI	Active
DSH230236AN	Child	DSH	METROPOLITAN HOSPITAL	UMH West Cascade FP (91600) - Family Practice	4300 Cascade Road SE	Grand Rapids	MI	Active
DSH230236AP	Child	DSH	METROPOLITAN HOSPITAL	UMH West Prof Bld Neurology (71750) - Neuruology	2122 Health Dr SW	Wyoming	MI	Active
DSH230236AQ	Child	DSH	METROPOLITAN HOSPITAL	UMH West Prof Bld Heart and Vascular - Heart and Vascular clinic	2122 Health Drive SW	Wyoming	MI	Active
DSH230236AR	Child	DSH	METROPOLITAN HOSPITAL	UMH West Prof Bld H&V Cardio Rehab (70302) - Heart and Vascular rehab	2122 Health Drive SW	Wyoming	MI	Active
DSH230236AS	Child	DSH	METROPOLITAN HOSPITAL	UMH West Prof Bld Vein Therapy (70317) - Vein Therapy	2122 Health Drive SW	Wyoming	MI	Active
DSH230236AT	Child	DSH	METROPOLITAN HOSPITAL	UMHealth-West HealthPark Colorectal Surgery (94250) - Colorectal Surgery	2093 Health Dr SW	Wyoming	MI	Approved
DSH230236B	Child	DSH	METROPOLITAN HOSPITAL	METRO HEALTH ALLENDALE	4830 BECKER DRIVE	ALLENDALE	MI	Terminated
DSH230236C	Child	DSH	METROPOLITAN HOSPITAL	METROPOLITAN HOSPITAL / Metro Health Podiatry	4200 N DIVISION AVENUE	COMSTOCK PARK	MI	Active
DSH230236D	Child	DSH	METROPOLITAN HOSPITAL	Metro Health Endoscopy	2093 Health Drive SW	Wyoming	MI	Active
DSH230236E	Child	DSH	METROPOLITAN HOSPITAL	METRO HEALTH / Gastroenterology	2093 Health Drive SW	WYOMING	MI	Active
DSH230236F	Child	DSH	METROPOLITAN HOSPITAL	METRO HEALTH / Surgical Oncology	2122 HEALTH DRIVE SW	WYOMING	MI	Active
DSH230236G	Child	DSH	METROPOLITAN HOSPITAL	Metro Health Pulmonology	2122 Health Drive SW	Wyoming	MI	Active
DSH230236H	Child	DSH	METROPOLITAN HOSPITAL	METRO HEALTH / ENT	4055 Cascade Road SE	GRAND RAPIDS	MI	Active
DSH230236J	Child	DSH	METROPOLITAN HOSPITAL	METRO HEALTH SPORTS MEDICINE CENTER	4300 Cascade Rd SE	Grand Rapids	MI	Terminated
DSH230236K	Child	DSH	METROPOLITAN HOSPITAL	METRO HEALTH ROCKFORD	4685 BELDING RD	ROCKFORD	MI	Active
DSH230236L	Child	DSH	METROPOLITAN HOSPITAL	METRO HEALTH COMSTOCK PARK	4200 N DIVISION	COMSTOCK	MI	Active
DSH230236M	Child	DSH	METROPOLITAN HOSPITAL	METRO HEALTH CEDAR SPRINGS	14211 WHITE CREEK AVE NE	CEDAR SPRINGS	MI	Active
DSH230236N	Child	DSH	METROPOLITAN HOSPITAL	METRO HEALTH / Wayland	1113 W. SUPERIOR STREET	WAYLAND	MI	Active
DSH230236P	Child	DSH	METROPOLITAN HOSPITAL	Metro Health Neurology	2122 Health Drive	Wyoming	MI	Active
DSH230236Q	Child	DSH	METROPOLITAN HOSPITAL	HEALTH PARK / Internal Medicine	2215 44th Street SW	WYOMING	MI	Terminated
DSH230236R	Child	DSH	METROPOLITAN HOSPITAL	METRO HEALTH BELTLINE	1310 East Beltline SE	GRAND RAPIDS	MI	Active
DSH230236S	Child	DSH	METROPOLITAN HOSPITAL	METRO HEALTH SOUTHWEST	2215 44TH ST SW	WYOMING	MI	Active
DSH230236T	Child	DSH	METROPOLITAN HOSPITAL	METRO HEALTH HUDSONVILLE	3912 32ND AVE	HUDSONVILLE	MI	Active
DSH230236U	Child	DSH	METROPOLITAN HOSPITAL	UMH-WEST - CALEDONIA HEALTH CENTER	8941 N RODGERS CT SE	CALEDONIA	MI	Active
DSH230236V	Child	DSH	METROPOLITAN HOSPITAL	METRO HEALTH JENISON	7686 GEORGETOWN CENTER DRIVE	JENISON	MI	Active
DSH230236W	Child	DSH	METROPOLITAN HOSPITAL	UMH-WEST - COMMUNITY HEALTH CENTER	781 36TH ST SE	WYOMING	MI	Active
DSH230236X	Child	DSH	METROPOLITAN HOSPITAL	Metro Health Park East / Outpatient Surgery Center	4055 CASCADE RD SE	GRAND RAPIDS	MI	Active
DSH230236Y	Child	DSH	METROPOLITAN HOSPITAL	UNIVERSITY OF MICHIGAN HEALTH-WEST - RHEUMATOLOGY / INFUSION CENTER - SUITE 106 - RHEUMATOLOGY / INFUSION CENTER	4055 CASCADE ROAD SE	GRAND RAPIDS	MI	Active
DSH230236Z	Child	DSH	METROPOLITAN HOSPITAL	UMH-W - SOUTHWEST ENT (91200) - PATIENT CARE - ENT	2215 44TH STREET SW	WYOMING	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 11:07 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
Addresses	Shipping Address	Delete	Recertification	UNIVERSITY OF MICHIGAN HEALTH-WEST PARK EAST PHARMACY 4055 CASCADE ROAD SE WYOMING, MI 49546		8/21/2024 2:42 PM
Addresses	Shipping Address	Insert	Recertification		UNIVERSITY OF MICHIGAN HEALTH-WEST PARK EAST PHARMACY 4055 CASCADE ROAD SE Grand Rapids, MI 49546	8/21/2024 2:42 PM
Details	Last Recertification Date	Update	Recertification	8/14/2023 9:23:50 AM	8/21/2024 2:42:07 PM	8/21/2024 2:42 PM
Contacts	Primary Contact	Update	Group Change Request	Haverkamp, Peter Joseph Director of Pharmacy Services Metro Health Hospital 6162527216	Lee, Janine M Assistant Direct 340B Program University of Michigan 7349368210	7/23/2024 3:48 PM
Contacts	Authorizing Official	Update	Change Request	Kurtz, Kris CFO Metro Health Hospital 6162524844	Miller, David President University of Michigan Health Systems University of Michigan Hospitals and Health Centers 7346476313	3/6/2024 9:55 AM
Details	Last Recertification Date	Update	Recertification	8/24/2022 9:22:25 AM	8/14/2023 9:23:50 AM	8/14/2023 9:23 AM
Details	Last Recertification Date	Update	Recertification		8/24/2022 9:22:25 AM	8/24/2022 9:22 AM
Details	State	Update		Approved	Active	7/1/2022 12:01 AM
Contacts	Signed By	Insert	New Registration		Kurtz, Kris CFO Metro Health Hospital 6162524844	4/20/2022 8:15 AM
Details	340B ID	Update	New Registration		DSH230236Y	4/20/2022 8:15 AM
Details	Entity Subname	Update	New Registration	UNIVERSITY OF MICHIGAN HEALTH-WEST - RHEUMATOLOGY / INFUSION CENTER - SUITE 106	UNIVERSITY OF MICHIGAN HEALTH-WEST - RHEUMATOLOGY / INFUSION CENTER - SUITE 106 - RHEUMATOLOGY / INFUSION CENTER	4/20/2022 8:15 AM
Dates	Participating Approval Date	Update	New Registration		4/20/2022 8:15:36 AM	4/20/2022 8:15 AM
Details	State	Update	New Registration	Pending	Approved	4/20/2022 8:15 AM
Dates	Signed By Date	Update	New Registration		4/15/2022 4:21:13 PM	4/20/2022 8:15 AM
Dates	Start Date	Update	New Registration		7/1/2022 12:00:00 AM	4/20/2022 8:15 AM
Addresses	Main Address	Insert	New Registration		4055 CASCADE ROAD SE SUITE 106 GRAND RAPIDS, MI 49546	4/15/2022 4:03 PM
Addresses	Shipping Address	Insert	New Registration		UNIVERSITY OF MICHIGAN HEALTH-WEST PARK EAST PHARMACY 4055 CASCADE ROAD SE WYOMING, MI 49546	4/15/2022 4:03 PM
Contacts	Primary Contact	Insert	New Registration		Haverkamp, Peter Joseph Director of Pharmacy Services Metro Health Hospital 6162527216	4/15/2022 4:03 PM
Contacts	Authorizing Official	Insert	New Registration		Kurtz, Kris CFO Metro Health Hospital 6162524844	4/15/2022 4:03 PM
Details	Assistance Received From Date	Insert	New Registration			4/15/2022 4:03 PM
Details	Assistance Received To Date	Insert	New Registration			4/15/2022 4:03 PM
Details	Last Recertification Date	Insert	New Registration			4/15/2022 4:03 PM
Details	Grant Number	Insert	New Registration			4/15/2022 4:03 PM
Details	340B ID	Insert	New Registration			4/15/2022 4:03 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/15/2022 4:03 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/15/2022 4:03 PM
Details	Medicare Provider Number	Insert	New Registration		230236	4/15/2022 4:03 PM
Details	Entity Name	Insert	New Registration		METROPOLITAN HOSPITAL	4/15/2022 4:03 PM
Details	NOFO Number	Insert	New Registration			4/15/2022 4:03 PM
Details	Program Code	Insert	New Registration		DSH	4/15/2022 4:03 PM
Details	Entity Subname	Insert	New Registration		UNIVERSITY OF MICHIGAN HEALTH-WEST - RHEUMATOLOGY / INFUSION CENTER - SUITE 106	4/15/2022 4:03 PM
Dates	Participating Approval Date	Insert	New Registration			4/15/2022 4:03 PM
Details	State	Insert	New Registration		Pending	4/15/2022 4:03 PM
Dates	Registration Date	Insert	New Registration		4/15/2022 4:03:54 PM	4/15/2022 4:03 PM
Dates	Signed By Date	Insert	New Registration			4/15/2022 4:03 PM
Dates	Start Date	Insert	New Registration			4/15/2022 4:03 PM
Terminations	Termination Comments	Insert	New Registration			4/15/2022 4:03 PM
Terminations	Termination Date	Insert	New Registration			4/15/2022 4:03 PM
Terminations	Termination Effective Date	Insert	New Registration			4/15/2022 4:03 PM
Terminations	Termination Reason	Insert	New Registration			4/15/2022 4:03 PM