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RWII496841 Munson Medical Center (Terminated)
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Main Details
Name
Munson Medical Center
Subdivision Name
Thomas Judd Care Center
Type
Ryan White Part B
340B ID
RWII496841
Grant Number
X07HA00044
Additional Details
Current Program Status
Terminated
Registration Date
7/1/2015
Participating Start Date
10/1/2015
Participating Approval Date
9/9/2015
Last Recertification Date
1/29/2024
Time Period the Assistance was Received
4/1/2022 - 3/31/2027
Termination Date
Termination Reason
1/1/2025
Other
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
5041 N. Royal Drive
Suite 1
Traverse City, MI 49684
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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April 2025
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