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DSH230021AL LAKELAND REGIONAL HEALTH SYSTEM LAKELAND MEDICAL CENTER ST JOSEPH (Terminated)
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Main Details
Name
LAKELAND REGIONAL HEALTH SYSTEM LAKELAND MEDICAL CENTER ST JOSEPH
Subdivision Name
Home Care Niles - Home Care
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH230021AL
Medicare Provider Number
230021
Outpatient Facility Provider Number
230021
Additional Details
Current Program Status
Terminated
Registration Date
7/19/2019
Participating Start Date
10/1/2019
Participating Approval Date
9/3/2019
Last Recertification Date
Termination Date
Termination Reason
10/1/2020
Business decision by the Covered Entity
Contacts
Authorizing Official
Spectrum Health
Paul Vincent Konopacki, VP Finance & CFO
(269) 313-7188 Ext: 2693137188
Primary Contact
Lakeland Health
MICHAEL J. TAYLOR, 340B COORDINATOR
(269) 687-1877
Addresses
Street Address
2 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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