340B Drug Pricing Program Database
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DSH230121AN The Memorial Hospital d/b/a Memorial Healthcare (Active)
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Main Details
Name
The Memorial Hospital d/b/a Memorial Healthcare
Subdivision Name
Memorial Healthcare Allergy & Immunology
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH230121AN
Medicare Provider Number
230121
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/2/2024
Participating Start Date
10/1/2024
Participating Approval Date
7/17/2024
Last Recertification Date
Contacts
Authorizing Official
Memorial Healthcare
Jorri Tremain, Chief Financial Officer
(989) 729-4466
Primary Contact
Memorial Healthcare
Tessa Luna, 340B Coordinator
(989) 721-2349
Addresses
Street Address
317 S. Elm St
Ste 205A
Owosso, MI 48867
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating from effective date: (07/01/2020) until terminated effective date: (07/01/2024); reinstatement effective date: (10/01/2024)
07/16/2024
June 2025
June 2025
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