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CAH231322-00 MUNSON HEALTHCARE CHARLEVOIX HOSPITAL (Active)
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Main Details
Name
MUNSON HEALTHCARE CHARLEVOIX HOSPITAL
Subdivision Name
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH231322-00
Medicare Provider Number
231322
Additional Details
Current Program Status
Active
Registration Date
9/2/2010
Participating Start Date
10/1/2012
Participating Approval Date
9/28/2012
Last Recertification Date
8/26/2024
Contacts
Authorizing Official
Munson Healthcare
Kathleen M LaRaia, Vice President
(231) 392-8410
Primary Contact
Munson Healthcare
Sam Patrick Niemi, System Director Reimbursement
(231) 935-7761
Addresses
Street Address
14700 LAKE SHORE DRIVE
CHARLEVOIX, MI 49720-1931
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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9/28/12 participating 9/27/10 thru 6/30/12, not participating 7/1/12 thru 9/30/12
09/28/2012
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April 2025
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