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DSH230121Q The Memorial Hospital d/b/a Memorial Healthcare (Terminated)
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Main Details
Name
The Memorial Hospital d/b/a Memorial Healthcare
Subdivision Name
HEALTH PARTNERS FOR WOMEN
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH230121Q
Medicare Provider Number
230121
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/13/2016
Participating Start Date
7/1/2016
Participating Approval Date
4/26/2016
Last Recertification Date
8/23/2018
Termination Date
Termination Reason
10/1/2019
Site closure
Contacts
Authorizing Official
Memorial Healthcare
Colleen Koppenhaver, Chief Financial Officer
(989) 729-4824
Primary Contact
Memorial Healthcare
Elizabeth Linder, Ambulatory Care Pharmacy Manager
(989) 729-4793
Addresses
Street Address
802 W KING ST STE E
OWOSSO, MI 48867-2117
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
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