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DSH230121AZ The Memorial Hospital d/b/a Memorial Healthcare (Active)
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Main Details
Name
The Memorial Hospital d/b/a Memorial Healthcare
Subdivision Name
MEMORIAL HEALTHCARE PULMONOLOGY - Pulmonology
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH230121AZ
Medicare Provider Number
230121
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/2/2024
Participating Start Date
10/1/2024
Participating Approval Date
7/17/2024
Last Recertification Date
Contacts
Authorizing Official
Memorial Healthcare
Jorri Tremain, Chief Financial Officer
(989) 729-4466
Primary Contact
Memorial Healthcare
Tessa Luna, 340B Coordinator
(989) 721-2349
Addresses
Street Address
802 W. King St
STE J
OWOSSO, MI 48867-2120
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
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