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DSH230121AA 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
Memorial Healthcare Family Medicine Main Street
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH230121AA
Medicare Provider Number
230121
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/5/2017
Participating Start Date
7/1/2017
Participating Approval Date
5/11/2017
Last Recertification Date
9/7/2021
Termination Date
Termination Reason
10/1/2022
Site closure
Contacts
Authorizing Official
Memorial Healthcare
Jorri Tremain, Chief Financial Officer
(989) 729-4466
Primary Contact
Memorial Healthcare
Hanna McCartney, 340B Program Manager
(989) 729-4373
Addresses
Street Address
1975 W M 21
104
Owosso, MI 48867
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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