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DSH230038C Corewell Health Grand Rapids Hospitals Butterworth Hospital (Active)
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Main Details
Name
Corewell Health Grand Rapids Hospitals Butterworth Hospital
Subdivision Name
Surgery - Lake Drive
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH230038C
Medicare Provider Number
230038
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
11/28/2006
Participating Start Date
1/1/2007
Participating Approval Date
11/28/2006
Last Recertification Date
8/20/2024
Contacts
Authorizing Official
Corewell Health
Hardik Dalal, SVP, Finance & System-wide Pharmacy Finance
(312) 771-0810
Primary Contact
Corewell Health
Lacey Alviar, Business Intell Analyst, Sr
(616) 391-1179
Addresses
Street Address
4069 LAKE DRIVE SE
Suite 210
GRAND RAPIDS, MI 49546
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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7/20/07 - ADDED SHIP TO ADDRESS
11/28/2006
April 2025
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