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SCH230058-00 MUNSON HEALTHCARE GRAYLING HOSPITAL (Active)
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Main Details
Name
MUNSON HEALTHCARE GRAYLING HOSPITAL
Subdivision Name
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH230058-00
Medicare Provider Number
230058
Additional Details
Current Program Status
Active
Registration Date
1/12/2024
Participating Start Date
4/1/2024
Participating Approval Date
2/6/2024
Last Recertification Date
8/20/2024
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
1100 E Michigan Ave
GRAYLING, MI 49738
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating Start Date 7/1/2012,Termination Date 4/1/2022, Reinstatement 4/1/2024
02/05/2024
April 2025
April 2025
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