| Details | Last Recertification Date | Update | Recertification | 2/8/2024 3:05:28 PM | 2/24/2025 3:21:57 PM | 2/24/2025 3:21 PM |
| Medicaid Billing | NPI: Number | Insert | Change Request | | 1578272258 | 1/14/2025 3:40 PM |
| Medicaid Billing | NPI: State | Insert | Change Request | | MI | 1/14/2025 3:40 PM |
| Details | Last Recertification Date | Update | Recertification | 2/21/2023 3:12:40 PM | 2/8/2024 3:05:28 PM | 2/8/2024 3:05 PM |
| Details | Last Recertification Date | Update | Recertification | 2/12/2022 12:21:28 AM | 2/21/2023 3:12:40 PM | 2/21/2023 3:12 PM |
| Details | Last Recertification Date | Update | Recertification | 2/5/2021 4:12:31 PM | 2/12/2022 12:21:28 AM | 2/12/2022 12:21 AM |
| Medicaid Billing | NPI: State | Update | Recertification | | MI | 2/5/2021 4:12 PM |
| Medicaid Billing | NPI: State | Update | Recertification | | MI | 2/5/2021 4:12 PM |
| Details | Last Recertification Date | Update | Recertification | 2/7/2020 11:03:08 AM | 2/5/2021 4:12:31 PM | 2/5/2021 4:12 PM |
| Addresses | Billing Address | Update | Recertification | CHERRY STREET HEALTH SERVICES, INC.
100 CHERRY STREET S.E.
GRAND RAPIDS, MI 49503 | CHERRY STREET SERVICES, INC.
100 CHERRY STREET S.E.
GRAND RAPIDS, MI 49503 | 2/7/2020 11:03 AM |
| Details | Last Recertification Date | Update | Recertification | 1/31/2019 5:29:08 PM | 2/7/2020 11:03:08 AM | 2/7/2020 11:03 AM |
| Details | Last Recertification Date | Update | Recertification | 2/9/2018 11:17:29 AM | 1/31/2019 5:29:08 PM | 1/31/2019 5:29 PM |
| Medicaid Billing | NPI: Number | Insert | Change Request | | 1568730745 | 11/21/2018 10:54 AM |
| Contacts | Authorizing Official | Update | Change Request | SHEA, CHRIS
CEO
Cherry Street Services,Inc.
6167762129 | Blackmon, Tasha
CEO
Cherry Street Services Inc
6169658215 | 3/26/2018 2:01 PM |
| Details | Last Recertification Date | Update | Recertification | 2/2/2017 12:00:00 AM | 2/9/2018 11:17:29 AM | 2/9/2018 11:17 AM |
| Contacts | Authorizing Official | Update | | SHEA, CHRIS
CEO
6167762129 | SHEA, CHRIS
CEO
Cherry Street Services,Inc.
6167762129 | 1/8/2018 4:50 PM |
| Contacts | Primary Contact | Update | | Gingrich, Brett
Pharmacy Director
6169658278 | Gingrich, Brett
Pharmacy Director
Cherry Street Services Inc
6169658278-7139 | 9/19/2017 11:54 AM |
| Contacts | Primary Contact | Update | | SCHMIDT, FREDERICK E.
PHARMACY DIRECTOR
6169658278 | Gingrich, Brett
Pharmacy Director
6169658278 | 8/7/2017 3:05 PM |
| Contacts | Authorizing Official | Update | | SHEA, CHRIS
CEO
6169658200-2129 | SHEA, CHRIS
CEO
6167762129 | 8/7/2017 3:05 PM |
| Addresses | Main Address | Insert | | |
550 Cherry St SE
Grand Rapids, MI 49503-4748 | 8/3/2017 11:27 AM |
| Addresses | Billing Address | Insert | | | CHERRY STREET HEALTH SERVICES, INC.
100 CHERRY STREET S.E.
GRAND RAPIDS, MI 49503 | 8/3/2017 11:27 AM |
| Contacts | Primary Contact | Update | | PLATT, THOMAS
MEDICAL DIRECTOR
6169658200-8225 | SCHMIDT, FREDERICK E.
PHARMACY DIRECTOR
6169658278 | 2/2/2017 5:29 PM |
| Details | Last Recertification Date | Update | | 2/18/2016 12:00:00 AM | 2/2/2017 12:00:00 AM | 2/2/2017 5:29 PM |
| Details | Last Recertification Date | Update | | 3/4/2015 12:00:00 AM | 2/18/2016 12:00:00 AM | 2/18/2016 3:48 PM |
| Details | Last Recertification Date | Update | | 2/14/2014 12:00:00 AM | 3/4/2015 12:00:00 AM | 3/4/2015 11:54 AM |
| Details | Entity Name | Update | | CHERRY STREET HEALTH SERVICES, INC. | CHERRY STREET SERVICES, INC. | 3/31/2014 4:25 PM |
| Details | Last Recertification Date | Update | | 4/1/2013 12:00:00 AM | 2/14/2014 12:00:00 AM | 2/14/2014 2:14 PM |
| Medicaid Billing | NPI: Number | Insert | | | 1558459164 | 10/1/2013 7:55 AM |
| Details | Last Recertification Date | Update | | | 4/1/2013 12:00:00 AM | 3/15/2013 9:45 AM |
| Contacts | Primary Contact | Insert | | | PLATT, THOMAS
MEDICAL DIRECTOR
6169658200-8225 | 2/16/2012 4:31 PM |
| Contacts | Authorizing Official | Insert | | | SHEA, CHRIS
CEO
6169658200-2129 | 2/16/2012 4:31 PM |
| Details | Comments Public | Insert | | | 8/18/09 CORRECTED PHYSICAL AND BILL TO ADDR; 12/12/07- UPDATED BILLING ADD (WAS 550 CHERRY STREET, S.E.)
2/16/12-CHANGED BILLING ADDRESS-WAS 540 CHERRY STREET, S.E.
| 2/16/2012 4:19 PM |
| Details | Last Recertification Date | Insert | | | | 8/18/2009 8:20 AM |
| Details | Grant Number | Insert | | | H80CS00770 | 8/18/2009 8:20 AM |
| Details | 340B ID | Insert | | | CH052030 | 8/18/2009 8:20 AM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 8/18/2009 8:20 AM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 8/18/2009 8:20 AM |
| Details | Medicare Provider Number | Insert | | | | 8/18/2009 8:20 AM |
| Details | Entity Name | Insert | | | CHERRY STREET HEALTH SERVICES, INC. | 8/18/2009 8:20 AM |
| Details | Program Code | Insert | | | CH | 8/18/2009 8:20 AM |
| Details | Entity Subname | Insert | | | CHERRY STREET HEALTH CENTER | 8/18/2009 8:20 AM |
| Dates | Participating Approval Date | Insert | | | 8/18/2009 12:00:00 AM | 8/18/2009 8:20 AM |
| Details | State | Insert | | | Active | 8/18/2009 8:20 AM |
| Dates | Registration Date | Insert | | | 7/1/2002 12:00:00 AM | 8/18/2009 8:20 AM |
| Dates | Signed By Date | Insert | | | | 8/18/2009 8:20 AM |
| Dates | Start Date | Insert | | | 7/1/2002 12:00:00 AM | 8/18/2009 8:20 AM |
| Terminations | Termination Comments | Insert | | | | 8/18/2009 8:20 AM |
| Terminations | Termination Date | Insert | | | | 8/18/2009 8:20 AM |
| Terminations | Termination Effective Date | Insert | | | | 8/18/2009 8:20 AM |
| Terminations | Termination Reason | Insert | | | | 8/18/2009 8:20 AM |
| Details | Comments Public | Insert | | | 8/18/09 CORRECTED PHYSICAL AND BILL TO ADDR; 12/12/07- UPDATED BILLING ADD (WAS 550 CHERRY STREET, S.E.) | 8/18/2009 8:20 AM |