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SCH230055-14 Marshfield Medical Center - Dickinson (Active)
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Main Details
Name
Marshfield Medical Center - Dickinson
Subdivision Name
Marshfield Medical Center - Dickinson Internal Medicine and Nephrology
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH230055-14
Medicare Provider Number
230055
Outpatient Facility Provider Number
238656
Additional Details
Current Program Status
Active
Registration Date
7/11/2014
Participating Start Date
7/1/2017
Participating Approval Date
9/4/2014
Last Recertification Date
8/23/2024
Contacts
Authorizing Official
MMC-DCH
Amanda Shelast, President-Marshfield Medical Center-Dickinson
(906) 774-1313
Primary Contact
Marshfield Medical Center
Kirstia Neuendorf, 340B Program Manager
(715) 858-4308
Addresses
Street Address
1711 S. Stephenson Avenue
Suite 225
Iron Mountain, MI 49801
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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6/14/17 Participated starting 10/1/2014, terminated 10/1/2016. Reinstated 7/1/2017.
06/14/2017
May 2025
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