Covered Entity Details

DSH230035H Corewell Health Greenville Hospital (Active) - information as of 6/26/2025 12:30:46 AM

Main Details

Name

Corewell Health Greenville Hospital

Subdivision Name

Internal Medicine/Pediatrics - Greenville

Type

Disproportionate Share Hospital

Rural

340B ID

DSH230035H

Medicare Provider Number

230035

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/12/2022

Participating Start Date

1/1/2023

Participating Approval Date

11/2/2022

Last Recertification Date

8/14/2024

Contacts

Authorizing Official

Corewell Health
Amanda Knuth, Finance Controller
(231) 592-4305

Primary Contact

Corewell Health
Lacey Alviar, Business Intell Analyst, Sr
(616) 391-1179

Addresses

Street Address

707 S GREENVILLE WEST DRIVE
GREENVILLE, MI 48838-3514

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		1477927184

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
DSH230035A	Child	DSH	Corewell Health Greenville Hospital	OB/Gyn and Greenville Family Medicine	1202 W. Oak St.	Greenville	MI	Active
DSH230035B	Child	DSH	SPECTRUM HEALTH UNITED HOSPITAL	Spectrum Health United Hospital - Wound Clinic	1208 W. Oak St	GREENVILLE	MI	Terminated
DSH230035C	Child	DSH	Corewell Health Greenville Hospital	Family Medicine - Belding	1227 W. State St.	Belding	MI	Active
DSH230035D	Child	DSH	Corewell Health Greenville Hospital	Family Medicine - Lakeview	8650 Howard City Edmore Rd.	Lakeview	MI	Active
DSH230035E	Child	DSH	Corewell Health Greenville Hospital	General Surgery	707 S GREENVILLE WEST DRIVE	GREENVILLE	MI	Active
DSH230035F	Child	DSH	Corewell Health Greenville Hospital	Orthopedics	707 S GREENVILLE WEST DRIVE	GREENVILLE	MI	Active
DSH230035G	Child	DSH	Corewell Health Greenville Hospital	Walk-in Clinic - Greenville	1202 W OAK ST	GREENVILLE	MI	Active
DSH230035H	Child	DSH	Corewell Health Greenville Hospital	Internal Medicine/Pediatrics - Greenville	707 S GREENVILLE WEST DRIVE	GREENVILLE	MI	Active
DSH230035J	Child	DSH	Corewell Health Greenville Hospital	Family Medicine - Greenville - Family Medicine	1202 W Oak St	Greenville	MI	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Group Change Request	Alviar, Lacey Business Intelligence Analyst Spectrum Health Hospital 6163911179	Alviar, Lacey Business Intell Analyst, Sr Corewell Health 6163911179	12/5/2024 11:31 AM
Contacts	Authorizing Official	Update	Change Request	Knuth, Amanda Controller Corewell Health 2315924305	Knuth, Amanda Finance Controller Corewell Health 2315924305	10/28/2024 1:49 PM
Details	Last Recertification Date	Update	Recertification	8/28/2023 9:31:30 AM	8/14/2024 10:12:54 AM	8/14/2024 10:12 AM
Details	Entity Name	Update	Change Request	SPECTRUM HEALTH UNITED HOSPITAL	Corewell Health Greenville Hospital	9/19/2023 2:27 PM
Addresses	Main Address	Update	Change Request	707 S GREENVILLE WEST DRIVE SPECTRUM HEALTH UNITED IM/PEDS GREENVILLE, MI 48838-3514	707 S GREENVILLE WEST DRIVE GREENVILLE, MI 48838-3514	9/19/2023 2:27 PM
Details	Entity Subname	Update	Change Request	SPECTRUM HEALTH UNITED - Internal Medicine/Pediatrics - Greenville	Internal Medicine/Pediatrics - Greenville	9/19/2023 2:27 PM
Details	Last Recertification Date	Update	Recertification		8/28/2023 9:31:30 AM	8/28/2023 9:31 AM
Details	State	Update		Approved	Active	1/1/2023 12:01 AM
Contacts	Authorizing Official	Update	Change Request	Sella, John Senior Director, Finance Spectrum Health Gerber 6166439168	Knuth, Amanda Controller Corewell Health 2315924305	11/7/2022 1:53 PM
Contacts	Signed By	Insert	New Registration		Sella, John Senior Director, Finance Spectrum Health Gerber 6166439168	11/2/2022 10:23 AM
Details	340B ID	Update	New Registration		DSH230035H	11/2/2022 10:23 AM
Details	Entity Name	Update	New Registration	SPECTRUM HEALTH UNITED MEMORIAL	SPECTRUM HEALTH UNITED HOSPITAL	11/2/2022 10:23 AM
Details	Entity Subname	Update	New Registration	SPECTRUM HEALTH UNITED	SPECTRUM HEALTH UNITED - Internal Medicine/Pediatrics - Greenville	11/2/2022 10:23 AM
Dates	Participating Approval Date	Update	New Registration		11/2/2022 10:23:22 AM	11/2/2022 10:23 AM
Details	State	Update	New Registration	Pending	Approved	11/2/2022 10:23 AM
Dates	Signed By Date	Update	New Registration		11/1/2022 3:34:57 PM	11/2/2022 10:23 AM
Dates	Start Date	Update	New Registration		1/1/2023 12:00:00 AM	11/2/2022 10:23 AM
Addresses	Main Address	Insert	New Registration		707 S GREENVILLE WEST DRIVE SPECTRUM HEALTH UNITED IM/PEDS GREENVILLE, MI 48838-3514	10/12/2022 12:59 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1477927184	10/12/2022 12:59 PM
Medicaid Billing	NPI: State	Insert	New Registration		MI	10/12/2022 12:59 PM
Contacts	Authorizing Official	Insert	New Registration		Sella, John Senior Director, Finance Spectrum Health Gerber 6166439168	10/12/2022 12:59 PM
Contacts	Primary Contact	Insert	New Registration		Alviar, Lacey Business Intelligence Analyst Spectrum Health Hospital 6163911179	10/12/2022 12:59 PM
Details	Assistance Received From Date	Insert	New Registration			10/12/2022 12:59 PM
Details	Assistance Received To Date	Insert	New Registration			10/12/2022 12:59 PM
Details	Last Recertification Date	Insert	New Registration			10/12/2022 12:59 PM
Details	Grant Number	Insert	New Registration			10/12/2022 12:59 PM
Details	340B ID	Insert	New Registration			10/12/2022 12:59 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/12/2022 12:59 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/12/2022 12:59 PM
Details	Medicare Provider Number	Insert	New Registration		230035	10/12/2022 12:59 PM
Details	Entity Name	Insert	New Registration		SPECTRUM HEALTH UNITED MEMORIAL	10/12/2022 12:59 PM
Details	NOFO Number	Insert	New Registration			10/12/2022 12:59 PM
Details	Program Code	Insert	New Registration		DSH	10/12/2022 12:59 PM
Details	Entity Subname	Insert	New Registration		SPECTRUM HEALTH UNITED	10/12/2022 12:59 PM
Dates	Participating Approval Date	Insert	New Registration			10/12/2022 12:59 PM
Details	State	Insert	New Registration		Pending	10/12/2022 12:59 PM
Dates	Registration Date	Insert	New Registration		10/12/2022 12:59:05 PM	10/12/2022 12:59 PM
Dates	Signed By Date	Insert	New Registration			10/12/2022 12:59 PM
Dates	Start Date	Insert	New Registration			10/12/2022 12:59 PM
Terminations	Termination Comments	Insert	New Registration			10/12/2022 12:59 PM
Terminations	Termination Date	Insert	New Registration			10/12/2022 12:59 PM
Terminations	Termination Effective Date	Insert	New Registration			10/12/2022 12:59 PM
Terminations	Termination Reason	Insert	New Registration			10/12/2022 12:59 PM