Covered Entity Details

RRC230117-17 ASCENSION BORGESS HOSPITAL (Active) - information as of 4/27/2025 12:53:18 AM

Main Details

Name

ASCENSION BORGESS HOSPITAL

Subdivision Name

KGH MSB - Ascension Medical Group-Kalamazoo Gastroenterology & Hepatology

Type

Rural Referral Center

Rural

340B ID

RRC230117-17

Medicare Provider Number

230117

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/2/2023

Participating Start Date

1/1/2024

Participating Approval Date

10/6/2023

Last Recertification Date

8/15/2024

Contacts

Authorizing Official

Ascension Michigan
Michael McCullough, CFO
(586) 753-0653

Primary Contact

Ascension Rx
Kelsey Fiser, 340B Program Director
(615) 222-5190

Addresses

Street Address

1535 Gull Road
105
Kalamazoo, MI 49048

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
RRC230117-01	Child	RRC	ASCENSION BORGESS HOSPITAL	PROMED FAMILY PRACTICE - Ascension Borgess ProMed Family Practice-Three Rivers	1241 WEST BROADWAY ST	THREE RIVERS	MI	Active
RRC230117-02	Child	RRC	ASCENSION BORGESS HOSPITAL	DELANO CLINIC - Ascension Borgess DeLano	8001 ANGLING RD	PORTAGE	MI	Terminated
RRC230117-03	Child	RRC	ASCENSION BORGESS HOSPITAL	PROMED FAMILY PRACTICE & PEDIATRICS - Ascension Borgess ProMed Family Practice & Pediatrics-Richland	8450 N 32ND ST	RICHLAND	MI	Active
RRC230117-04	Child	RRC	ASCENSION BORGESS HOSPITAL	BARIATRIC CENTER - Ascension Borgess Bariatric Center	1717 SHAFFER ST	KALAMAZOO	MI	Active
RRC230117-05	Child	RRC	ASCENSION BORGESS HOSPITAL	BORGESS PULMONARY & SLEEP MEDICINE - Ascension Borgess Critical Care Services	1535 GULL RD	KALAMAZOO	MI	Active
RRC230117-06	Child	RRC	ASCENSION BORGESS HOSPITAL	BSS General - Ascension Borgess Allegan General Surgery	551 Linn Street	Allegan	MI	Active
RRC230117-07	Child	RRC	ASCENSION BORGESS HOSPITAL	HEART FAILURE CLINIC - Ascension Borgess Heart Failure Clinic	1722 SHAFFER ST	KALAMAZOO	MI	Active
RRC230117-08	Child	RRC	ASCENSION BORGESS HOSPITAL	ASCENSION BORGESS HOSPITAL - Ascension Borgess Heart Institute	1722 SHAFFER ST	KALAMAZOO	MI	Active
RRC230117-09	Child	RRC	ASCENSION BORGESS HOSPITAL	BORGESS HEART INSTITUTE - Ascension Borgess Heart Institute	1722 SHAFFER ST	KALAMAZOO	MI	Active
RRC230117-10	Child	RRC	ASCENSION BORGESS HOSPITAL	BORGESS NEUROLOGY - Ascension Borgess Neurology	2845 CAPITAL AVE SW	BATTLE CREEK	MI	Active
RRC230117-11	Child	RRC	ASCENSION BORGESS HOSPITAL	BORGESS NEUROLOGY - Ascension Borgess Neurology	1541 GULL RD	KALAMAZOO	MI	Active
RRC230117-12	Child	RRC	ASCENSION BORGESS HOSPITAL	BORGESS WOMEN'S HEALTH - Ascension Borgess Women's Health	1535 GULL RD	KALAMAZOO	MI	Active
RRC230117-13	Child	RRC	ASCENSION BORGESS HOSPITAL	BORGESS ORTHOPEDICS - Ascension Borgess Bone & Joint Institute	2490 S 11TH ST	KALAMAZOO	MI	Active
RRC230117-14	Child	RRC	ASCENSION BORGESS HOSPITAL	BORGESS NEUROINTERVENTIONAL RADIOLO - Ascension Borgess Neurointerventional Radiology	1541 GULL RD	KALAMAZOO	MI	Active
RRC230117-15	Child	RRC	ASCENSION BORGESS HOSPITAL	BORGESS INTERNAL MEDICINE - Ascension Borgess Internal Medicine-Woodbridge	7775 ANGLING RD	PORTAGE	MI	Active
RRC230117-16	Child	RRC	ASCENSION BORGESS HOSPITAL	BORGESS DIABETES & ENDOCRINE CENTER - Ascension Borgess Diabetes Endocrine Center	3025 GULL RD	KALAMAZOO	MI	Active
RRC230117-17	Child	RRC	ASCENSION BORGESS HOSPITAL	KGH MSB - Ascension Medical Group-Kalamazoo Gastroenterology & Hepatology	1535 Gull Road	Kalamazoo	MI	Active
RRC230117-18	Child	RRC	ASCENSION BORGESS HOSPITAL	BIM Nrth Pro - Ascension Borgess Internal Medicine - MSB	1535 Gull Road	Kalamazoo	MI	Active
RRC230117-19	Child	RRC	ASCENSION BORGESS HOSPITAL	BORGESS CARDIOTHORACIC SURGERY - Ascension Borgess Cardiothoracic Surgery	1722 SHAFFER ST	KALAMAZOO	MI	Active
RRC230117-20	Child	RRC	ASCENSION BORGESS HOSPITAL	The Surgical Group - Ascension Borgess Allegan General Surgery	551 Linn Street	Allegan	MI	Active
RRC230117-21	Child	RRC	ASCENSION BORGESS HOSPITAL	PROMED FAMILY PRACTICE - Ascension Borgess ProMed Family Practice-Woodbridge	7901 ANGLING RD	PORTAGE	MI	Active
RRC230117-22	Child	RRC	ASCENSION BORGESS HOSPITAL	BORGESS FAMILY & INTERNAL MEDICINE - Ascension Borgess Internal Medicine-Health Park	3035 CAPITAL AVE SW	BATTLE CREEK	MI	Active
RRC230117-23	Child	RRC	ASCENSION BORGESS HOSPITAL	BORGESS NEUROSURGERY OF KALAMAZOO - Ascension Borgess Neurosurgery	1541 GULL RD	KALAMAZOO	MI	Active
RRC230117-24	Child	RRC	ASCENSION BORGESS HOSPITAL	ASCENSION BORGESS WOMENS HEALTH W - Ascension Borgess Women's Health	7901 ANGLING RD	PORTAGE	MI	Active
RRC230117-25	Child	RRC	ASCENSION BORGESS HOSPITAL	ASCENSION BORGESS INFUSION LAB - Infusion	2520 ROBERT JONES WAY	KALAMAZOO	MI	Active
RRC230117-26	Child	RRC	ASCENSION BORGESS HOSPITAL	ASCENSION BORGESS CANCER CENTER - ASCENSION BORGESS CANCER CENTER	2520 ROBERT JONES WAY	KALAMAZOO	MI	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification		8/15/2024 12:22:45 PM	8/15/2024 12:22 PM
Details	State	Update		Approved	Active	1/1/2024 12:01 AM
Contacts	Primary Contact	Update	Group Change Request	Pearce, Bryan 340B Program Director - North Region Ascension WI 7154790312	Fiser, Kelsey 340B Program Director Ascension Rx 6152225190	11/27/2023 12:15 PM
Contacts	Signed By	Insert	New Registration		McCullough, Michael CFO Ascension Michigan 5867530653	10/6/2023 6:53 AM
Details	340B ID	Update	New Registration		RRC230117-17	10/6/2023 6:53 AM
Details	Entity Subname	Update	New Registration	KGH MSB	KGH MSB - Ascension Medical Group-Kalamazoo Gastroenterology & Hepatology	10/6/2023 6:53 AM
Dates	Participating Approval Date	Update	New Registration		10/6/2023 6:53:14 AM	10/6/2023 6:53 AM
Details	State	Update	New Registration	Pending	Approved	10/6/2023 6:53 AM
Dates	Signed By Date	Update	New Registration		10/3/2023 3:09:53 PM	10/6/2023 6:53 AM
Dates	Start Date	Update	New Registration		1/1/2024 12:00:00 AM	10/6/2023 6:53 AM
Addresses	Main Address	Insert	New Registration		1535 Gull Road 105 Kalamazoo, MI 49048	10/2/2023 10:27 AM
Contacts	Primary Contact	Insert	New Registration		Pearce, Bryan 340B Program Director - North Region Ascension WI 7154790312	10/2/2023 10:27 AM
Contacts	Authorizing Official	Insert	New Registration		McCullough, Michael CFO Ascension Michigan 5867530653	10/2/2023 10:27 AM
Details	Assistance Received From Date	Insert	New Registration			10/2/2023 10:27 AM
Details	Assistance Received To Date	Insert	New Registration			10/2/2023 10:27 AM
Details	Last Recertification Date	Insert	New Registration			10/2/2023 10:27 AM
Details	Grant Number	Insert	New Registration			10/2/2023 10:27 AM
Details	340B ID	Insert	New Registration			10/2/2023 10:27 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/2/2023 10:27 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/2/2023 10:27 AM
Details	Medicare Provider Number	Insert	New Registration		230117	10/2/2023 10:27 AM
Details	Entity Name	Insert	New Registration		ASCENSION BORGESS HOSPITAL	10/2/2023 10:27 AM
Details	NOFO Number	Insert	New Registration			10/2/2023 10:27 AM
Details	Program Code	Insert	New Registration		RRC	10/2/2023 10:27 AM
Details	Entity Subname	Insert	New Registration		KGH MSB	10/2/2023 10:27 AM
Dates	Participating Approval Date	Insert	New Registration			10/2/2023 10:27 AM
Details	State	Insert	New Registration		Pending	10/2/2023 10:27 AM
Dates	Registration Date	Insert	New Registration		10/2/2023 10:27:02 AM	10/2/2023 10:27 AM
Dates	Signed By Date	Insert	New Registration			10/2/2023 10:27 AM
Dates	Start Date	Insert	New Registration			10/2/2023 10:27 AM
Terminations	Termination Comments	Insert	New Registration			10/2/2023 10:27 AM
Terminations	Termination Date	Insert	New Registration			10/2/2023 10:27 AM
Terminations	Termination Effective Date	Insert	New Registration			10/2/2023 10:27 AM
Terminations	Termination Reason	Insert	New Registration			10/2/2023 10:27 AM