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DSH230021A LAKELAND REGIONAL HEALTH SYSTEM LAKELAND MEDICAL CENTER ST JOSEPH (Terminated)
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Main Details
Name
LAKELAND REGIONAL HEALTH SYSTEM LAKELAND MEDICAL CENTER ST JOSEPH
Subdivision Name
LAKELAND MEDICAL CENTER NILES
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH230021A
Medicare Provider Number
230021
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
5/2/2008
Participating Start Date
1/1/2005
Participating Approval Date
5/2/2008
Last Recertification Date
8/20/2020
Termination Date
Termination Reason
4/1/2021
Other
Contacts
Authorizing Official
Spectrum Health
Paul Vincent Konopacki, VP Finance & CFO
(269) 313-7188 Ext: 2693137188
Primary Contact
Lakeland Regional Health
Michael James Taylor, 340B Coordinator
(269) 262-8670
Addresses
Street Address
31 N ST JOSEPH AVENUE
NILES, MI 49120
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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