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DSH230081 MUNSON HEALTHCARE CADILLAC HOSPITAL (Active)
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Main Details
Name
MUNSON HEALTHCARE CADILLAC HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH230081
Medicare Provider Number
230081
Additional Details
Current Program Status
Active
Registration Date
1/14/2022
Participating Start Date
4/1/2022
Participating Approval Date
2/23/2022
Last Recertification Date
8/20/2024
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
400 HOBART ST
CADILLAC, MI 49601
Billing Address
Northern Michigan Supply Alliance
Munson Healthcare Cadillac Hospital
PO Box 669
Traverse City, MI 49685
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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