340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
SCH230133-04 MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL (Active)
Print
Main Details
Name
MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL
Subdivision Name
OMH Walk-In Clinic
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH230133-04
Medicare Provider Number
230133
Outpatient Facility Provider Number
238606
Additional Details
Current Program Status
Active
Registration Date
7/12/2013
Participating Start Date
10/1/2013
Participating Approval Date
9/9/2013
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
1996 Walden Drive
Gaylord, MI 49735
Billing Address
Otsego Memorial Hospital
825 N CENTER AVE
Gaylord, MI 49735
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History
1
Item
0
to
0
of
0
Page:
of 1
Go
Page size:
Change
Comment
Last Updated On
1
Item
0
to
0
of
0
Page:
of 1
Go
Page size:
Change
No records to display.
May 2025
May 2025
week
S
M
T
W
T
F
S
18
27
28
29
30
1
2
3
19
4
5
6
7
8
9
10
20
11
12
13
14
15
16
17
21
18
19
20
21
22
23
24
22
25
26
27
28
29
30
31
23
1
2
3
4
5
6
7
NoFilter
Contains
DoesNotContain
StartsWith
EndsWith
EqualTo
NotEqualTo
GreaterThan
LessThan
GreaterThanOrEqualTo
LessThanOrEqualTo
Between
NotBetween
IsEmpty
NotIsEmpty
IsNull
NotIsNull
Custom
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session