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DSH230099 MONROE REGIONAL HOSPITAL (Active)
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Main Details
Name
MONROE REGIONAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH230099
Medicare Provider Number
230099
Additional Details
Current Program Status
Active
Registration Date
10/15/2021
Participating Start Date
1/1/2022
Participating Approval Date
11/18/2021
Last Recertification Date
8/27/2024
Contacts
Authorizing Official
ProMedica Monroe Regional Hospital
Joseph Raj Jr., Director Finance
(734) 240-4524
Primary Contact
Promedica Health Systems
Devan Matthew Ribley, Lead 340B Analyst
(567) 585-0154
Addresses
Street Address
718 NORTH MACOMB
MONROE, MI 48162
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating from effective date: (1/1/2017) until terminated effective date: (7/1/2018), reinstatement effective date: (01/01/2022)
11/18/2021
June 2025
June 2025
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