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DSH230121J The Memorial Hospital d/b/a Memorial Healthcare (Active)
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Main Details
Name
The Memorial Hospital d/b/a Memorial Healthcare
Subdivision Name
Memorial Healthcare Surgical Associates
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH230121J
Medicare Provider Number
230121
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/15/2020
Participating Start Date
4/1/2020
Participating Approval Date
3/9/2020
Last Recertification Date
8/22/2024
Contacts
Authorizing Official
Memorial Healthcare
Jorri Tremain, Chief Financial Officer
(989) 729-4466
Primary Contact
Memorial Healthcare
Tessa Luna, 340B Coordinator
(989) 721-2349
Addresses
Street Address
818 W KING ST
STE 201
OWOSSO, MI 48867
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 7/1/2016; Terminated on 10/1/2019; Reinstated on 4/1/2020.
03/09/2020
June 2025
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