340B Drug Pricing Program Database
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DSH230072AY HOLLAND HOSPITAL (Terminated)
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Main Details
Name
HOLLAND HOSPITAL
Subdivision Name
Specialty Suite
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH230072AY
Medicare Provider Number
230072
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/5/2016
Participating Start Date
10/1/2016
Participating Approval Date
8/24/2016
Last Recertification Date
11/8/2017
Termination Date
Termination Reason
10/1/2018
Business decision by the Covered Entity
Contacts
Authorizing Official
Holland Hospital
TERRY L. STEELE, CFO
(616) 392-5141
Primary Contact
Holland Hospital
Carol Fletcher, Sr. Director Revenue Integrity
(616) 394-3227
Addresses
Street Address
577 Michigan Ave
Suite 104
Holland, MI 49423
Billing Address
Specialty Suite
Dept 77635
PO Box 77000
Detroit, MI 48277-0635
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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