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SCH230222-19 MIDMICHIGAN MEDICAL CTR (Terminated)
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Main Details
Name
MIDMICHIGAN MEDICAL CTR
Subdivision Name
MIDMICHIGAN MEDICAL CENTER MIDLAND - Urogynocology
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH230222-19
Medicare Provider Number
230222
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/6/2017
Participating Start Date
1/1/2018
Participating Approval Date
10/31/2017
Last Recertification Date
8/20/2019
Termination Date
Termination Reason
10/1/2019
Business decision by the Covered Entity
Contacts
Authorizing Official
MidMichigan Health
Bryan Rex Cross, President
(989) 839-1322
Primary Contact
MidMichigan Medical Center - Gratiot
Eileen Constantine, 340B Program Coordinator
(989) 466-7258
Addresses
Street Address
4320 Campus Ridge Drive
MIDLAND, MI 48640-6103
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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