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ASPIRUS KEWEENAW HOSPITAL
CAH231309-00 ASPIRUS ONTONAGON HOSPITAL
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Covered Entity Details
Entity Name
ASPIRUS ONTONAGON HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH231309-00
Entity Address
601 S. SEVENTH STREET
ONTONAGON, MI 49953
Medicare Provider Number
231309
Participating Start Date
1/1/2011
Last Recertification Date
8/24/2023
Entity Termination Date
7/1/2024
Pharmacy Details
Pharmacy Name
ASPIRUS KEWEENAW HOSPITAL
Pharmacy Address
205 OSCEOLA ST
LAURIUM, MI 49913
Pharmacy Comments
Contract Details
Approval Date
9/19/2022
Contract Begin Date
9/19/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
PAT TINCHER, Vice President-Finance, Regional Markets
(715) 847-2425
Contract Pharmacy Representative
Aspirus
Jessica Bessner, Director of Pharmacy
(906) 337-6527
Signed By Date
9/19/2022
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