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DSH230059AW SAINT MARY'S HEALTH CARE (Terminated)
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Main Details
Name
SAINT MARY'S HEALTH CARE
Subdivision Name
MHPP Rockford - Boulder Creek - Family Medicine
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH230059AW
Medicare Provider Number
230059
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/12/2018
Participating Start Date
7/1/2018
Participating Approval Date
4/25/2018
Last Recertification Date
9/10/2023
Termination Date
Termination Reason
10/1/2024
Site closure
Contacts
Authorizing Official
Trinity Health Muskegon Hospital
Daniel G. Green, Vice President for Finance
(616) 685-6709
Primary Contact
Saint Mary's Health Care
Robert D Bird, 340B Program Manager
(616) 685-1107
Addresses
Street Address
6070 Northland Drive
Rockford, MI 49341
Billing Address
Saint Mary's Health Care
200 Jefferson Ave SE
Grand Rapids, MI 49503
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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