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SCH230055-09 Dickinson County Healthcare System (Terminated)
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Main Details
Name
Dickinson County Healthcare System
Subdivision Name
DICKINSON DERMATOLOGY CLINIC
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH230055-09
Medicare Provider Number
230055
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/1/2013
Participating Start Date
7/1/2017
Participating Approval Date
8/26/2013
Last Recertification Date
8/29/2019
Termination Date
Termination Reason
10/1/2019
Site closure
Contacts
Authorizing Official
Dickinson County Healthcare System
Meghan Rossato, Performance Improvement, Operations and Analytics Director
(906) 776-5634
Primary Contact
Dickinson County Healthcare System
Laura Casanova, Manager of Pharmacy
(906) 776-5419
Addresses
Street Address
1711 S STEPHENSON AVE
115
IRON MOUNTAIN, MI 49801-3649
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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6/14/17 Participated starting 10/1/2013, terminated 10/1/2016. Reinstated 7/1/2017.
06/14/2017
May 2025
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