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DSH230058 MUNSON HEALTHCARE GRAYLING HOSPITAL (Terminated)
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Main Details
Name
MUNSON HEALTHCARE GRAYLING HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH230058
Medicare Provider Number
230058
Additional Details
Current Program Status
Terminated
Registration Date
1/7/2022
Participating Start Date
4/1/2022
Participating Approval Date
2/22/2022
Last Recertification Date
8/21/2023
Termination Date
Termination Reason
1/1/2024
DSH percentage below statutory minimum
Contacts
Authorizing Official
Munson Healthcare
Kathleen M LaRaia, Vice President
(231) 392-8410
Primary Contact
Munson Healthcare
Sam Patrick Niemi, System Director Reimbursement
(231) 935-7761
Addresses
Street Address
1100 E Michigan Ave
GRAYLING, MI 49738
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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