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RRC230227-20 MCLAREN MACOMB (Terminated)
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Main Details
Name
MCLAREN MACOMB
Subdivision Name
Hampton Medical Center - Hampton Med
Type
Rural Referral Center
Rural
Yes
340B ID
RRC230227-20
Medicare Provider Number
230227
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/2/2020
Participating Start Date
12/1/2020
Participating Approval Date
11/13/2020
Last Recertification Date
9/16/2022
Termination Date
Termination Reason
7/1/2023
Site closure
Contacts
Authorizing Official
McLaren Macomb
Brian Balutanski, Regional CFO
(586) 493-3044
Primary Contact
McLaren Health Care
Sharelle Brown, Corporate, 340B Program Director
(248) 396-8085
Addresses
Street Address
30550 Utica Road
Roseville, MI 48066
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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