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DSH230021E LAKELAND REGIONAL HEALTH SYSTEM (Terminated)
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Main Details
Name
LAKELAND REGIONAL HEALTH SYSTEM
Subdivision Name
Lakeland Home Infusion
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH230021E
Medicare Provider Number
230021
Outpatient Facility Provider Number
230021
Additional Details
Current Program Status
Terminated
Registration Date
7/10/2014
Participating Start Date
10/1/2014
Participating Approval Date
9/15/2014
Last Recertification Date
8/16/2016
Termination Date
Termination Reason
4/1/2017
Site closure
Contacts
Authorizing Official
Spectrum Health
Paul Vincent Konopacki, VP Finance & CFO
(269) 313-7188 Ext: 2693137188
Primary Contact
MARY SLEVIN, MANAGER OF PHARMACY SERVICES
(269) 985-4430
Addresses
Street Address
2550 Meadowbrook Road
Suite 106
Benton Harbor, MI 49022
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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