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DSH230121AM 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 Family Medicine/ Memorial Healthcare Occupational Medicine- Shiawassee
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH230121AM
Medicare Provider Number
230121
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/9/2020
Participating Start Date
7/1/2020
Participating Approval Date
4/10/2020
Last Recertification Date
9/10/2020
Termination Date
Termination Reason
7/1/2021
Site closure
Contacts
Authorizing Official
Memorial Healthcare
Colleen Koppenhaver, Chief Financial Officer
(989) 729-4824
Primary Contact
Memorial Healthcare
Kelli Pardee, 340B Program Manager
(989) 729-4373
Addresses
Street Address
208 N. Shiawassee St.
Owosso, MI 48867
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
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