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SCH230058-01 MUNSON HEALTHCARE GRAYLING HOSPITAL (Active)
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Main Details
Name
MUNSON HEALTHCARE GRAYLING HOSPITAL
Subdivision Name
Roscommon Community Health Center
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH230058-01
Medicare Provider Number
230058
Outpatient Facility Provider Number
238573
Additional Details
Current Program Status
Active
Registration Date
1/15/2024
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
234 Lake Street
Roscommon, MI 48653
Billing Address
Munson Healthcare Grayling Hospital
PO Box 669
Traverse City, MI 49685
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating Start Date 10/1/2013, Termination Date 4/1/2022, Reinstatement 4/1/2024
02/05/2024
9/17/2013 Site opted IN for orphan drugs but does not appear on the CY2013Q4 list due to approval following generation of the file.
09/17/2013
June 2025
June 2025
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