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DSH230021B 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 CENTER FOR OUTPATIENT SERVICES - ST JOSEPH
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH230021B
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
8/26/2022
Termination Date
Termination Reason
4/1/2023
Other
Contacts
Authorizing Official
Lakeland Regional Health
Natalie Baggio, SVP, Patient Care Services CNE LKD
(217) 825-8212
Primary Contact
Lakeland Regional Health
Michael James Taylor, 340B Coordinator
(269) 262-8670
Addresses
Street Address
3900 HOLLYWOOD ROAD
ST JOSEPH, MI 49085
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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