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DSH230021AK LAKELAND REGIONAL HEALTH SYSTEM LAKELAND MEDICAL CENTER ST JOSEPH DBA COREWELL HEALTH LAKELAND HOSPITALS (Terminated)
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Main Details
Name
LAKELAND REGIONAL HEALTH SYSTEM LAKELAND MEDICAL CENTER ST JOSEPH DBA COREWELL HEALTH LAKELAND HOSPITALS
Subdivision Name
Niles Recovery - Surgery
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH230021AK
Medicare Provider Number
230021
Outpatient Facility Provider Number
230021
Additional Details
Current Program Status
Terminated
Registration Date
7/12/2019
Participating Start Date
10/1/2019
Participating Approval Date
9/3/2019
Last Recertification Date
8/20/2024
Termination Date
Termination Reason
1/1/2025
Business decision by the Covered Entity
Contacts
Authorizing Official
Corewell Health
Hardik Dalal, SVP, Finance & System-wide Pharmacy Finance
(312) 771-0810
Primary Contact
Lakeland Regional Health DBA Corewell Health
Nicole Weston, Business Analyst
(269) 985-4431
Addresses
Street Address
31 N. St. Joseph Avenue
Niles, MI 49120
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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