340B Drug Pricing Program Database
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DSH230059AQ SAINT MARY'S HEALTH CARE (Terminated)
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Main Details
Name
SAINT MARY'S HEALTH CARE
Subdivision Name
Wyoming Family Practice
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH230059AQ
Medicare Provider Number
230059
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/15/2015
Participating Start Date
7/1/2015
Participating Approval Date
5/14/2015
Last Recertification Date
8/27/2019
Termination Date
Termination Reason
10/1/2020
Business decision by the Covered Entity
Contacts
Authorizing Official
Mercy Health Saint Mary's
Daniel G. Green, Vice President for Finance
(616) 685-6709
Primary Contact
DSH230059
Terry Kirkpatrick, Director of Pharmacy Services
(616) 685-6108
Addresses
Street Address
950 36th Street SW
Wyoming, MI 49509
Billing Address
Saint Mary's Health Care
200 Jefferson Street
Grand Rapids, MI 49503
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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