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DSH230121AJ 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 Institute for Neuroscience- St. Johns
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH230121AJ
Medicare Provider Number
230121
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/7/2019
Participating Start Date
1/1/2020
Participating Approval Date
10/8/2019
Last Recertification Date
9/10/2020
Termination Date
Termination Reason
10/1/2021
Other
Contacts
Authorizing Official
Memorial Healthcare
Colleen Koppenhaver, Chief Financial Officer
(989) 729-4824
Primary Contact
Memorial Healthcare
Hanna McCartney, 340B Program Manager
(989) 729-4373
Addresses
Street Address
1501 Waterford Pkwy
Ste B
St. Johns, MI 48879
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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