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DSH230035B SPECTRUM HEALTH UNITED HOSPITAL (Terminated)
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Main Details
Name
SPECTRUM HEALTH UNITED HOSPITAL
Subdivision Name
Spectrum Health United Hospital - Wound Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH230035B
Medicare Provider Number
230035
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/11/2014
Participating Start Date
7/1/2014
Participating Approval Date
6/11/2014
Last Recertification Date
8/30/2016
Termination Date
Termination Reason
10/1/2016
Site closure
Contacts
Authorizing Official
Spectrum Health
Tom Knoerl, Controller
(231) 592-4253
Primary Contact
Spectrum Health System - Grand Rapids, MI
Ryan Wells Foster, Dir. Pharmacy
(616) 391-3028
Addresses
Street Address
1208 W. Oak St
GREENVILLE, MI 48838
Billing Address
Spectrum Health United Hospital
615 S. Bower St.
Greenville, MI 48838
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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