340B Drug Pricing Program Database

Name

MCLAREN CENTRAL MICHIGAN

Subdivision Name

RHC - Burns Building Nephrology - Nephrology

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH230080AJ

Medicare Provider Number

230080

Outpatient Facility Provider Number

Current Program Status

Terminated

Registration Date

4/15/2022

Participating Start Date

7/1/2022

Participating Approval Date

5/10/2022

Last Recertification Date

9/13/2022

Termination Date
Termination Reason

1/1/2023
Business decision by the Covered Entity

Authorizing Official

DSH230080-00
Tara Soules, Chief Financial Officer
(989) 772-6818

Primary Contact

McLaren Health Care
Sharelle Brown, Corporate, 340B Program Director
(248) 396-8085

Street Address

560 West Mitchell St
Suite 160
Petoskey, MI 49770

Billing Address
Same as Street Address