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DSH230072BT HOLLAND HOSPITAL (Terminated)
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Main Details
Name
HOLLAND HOSPITAL
Subdivision Name
Endocrinology
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH230072BT
Medicare Provider Number
230072
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/11/2023
Participating Start Date
1/1/2024
Participating Approval Date
11/7/2023
Last Recertification Date
9/4/2024
Termination Date
Termination Reason
4/1/2025
Business decision by the Covered Entity
Contacts
Authorizing Official
Holland Hospital
Mark Pawlak, President
(616) 392-5141
Primary Contact
Holland Hospital
Zachary C Tamminga, Director Finance Administration
(616) 395-4472
Addresses
Street Address
3235 N Wellness Dr
Suite 120A
Holland, MI 49424
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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