Covered Entity Details

DSH230130C Corewell Health William Beaumont University Hospital (Active) - information as of 6/14/2025 10:06:57 AM

Main Details

Name

Corewell Health William Beaumont University Hospital

Subdivision Name

Corewell Health William Beaumont University Hospital Obstetrics & Gynecology - 3535 W 13 Mile Rd

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH230130C

Medicare Provider Number

230130

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/13/2024

Participating Start Date

4/1/2024

Participating Approval Date

2/5/2024

Last Recertification Date

8/21/2024

Contacts

Authorizing Official

Corewell Health
Hardik Dalal, SVP, Finance & System-wide Pharmacy Finance
(312) 771-0810

Primary Contact

Corewell Health
Thomas Schaible, Mgr, Pharmacy CHE
(947) 522-1169

Addresses

Street Address

3535 West 13 Mile Road
Suite 329
Royal Oak, MI 48073

Billing Address

WILLIAM BEAUMONT HOSPITAL dba Beaumont Hospital - Royal Oak
3601 WEST 13 MILE ROAD
ROYAL OAK, MI 48073

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
MI		1689653305

Shipping Addresses

Shipping Address 1

WILLIAM BEAUMONT HOSPITAL dba Beaumont Hospital - Royal Oak
3601 WEST 13 MILE ROAD
ROYAL OAK, MI 48073

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH230130A	Child	DSH	Corewell Health William Beaumont University Hospital	Corewell Health William Beaumont University Hospital Pediatric Genetics - 3555 West 13 Mile Rd	3555 West 13 Mile Rd	Royal Oak	MI	Active
DSH230130AA	Child	DSH	Corewell Health William Beaumont University Hospital	Corewell Health William Beaumont University Hospital Pediatric Infectious Disease - 3535 W 13 Mile Rd	3535 West 13 Mile Rd	Royal Oak	MI	Active
DSH230130AB	Child	DSH	Corewell Health William Beaumont University Hospital	Corewell Health William Beaumont University Hospital Pediatric Nephrology - 3535 W 13 Mile Rd	3535 West 13 Mile Rd	Royal Oak	MI	Active
DSH230130AC	Child	DSH	Corewell Health William Beaumont University Hospital	Corewell Health William Beaumont University Hospital Pain Management - 4949 Coolidge Hwy	4949 Coolidge Highway	Royal Oak	MI	Active
DSH230130AD	Child	DSH	Corewell Health William Beaumont University Hospital	Corewell Health William Beaumont University Hospital Eye Institute - 3535 W 13 Mile Rd	3535 West 13 Mile Road	Royal Oak	MI	Active
DSH230130AE	Child	DSH	Corewell Health William Beaumont University Hospital	Beaumont Liver Center-Royal Oak - Transplant Surgery	3535 West 13 Mile Rd	Royal Oak	MI	Active
DSH230130AF	Child	DSH	Corewell Health William Beaumont University Hospital	BEAUMONT MIDWEST THORACIC SURGERY - Thoracic Surgery	3577 W 13 MILE RD	ROYAL OAK	MI	Active
DSH230130AG	Child	DSH	Corewell Health William Beaumont University Hospital	Corewell Health William Beaumont University Hospital Heart & Vascular Center - 4949 Coolidge Hwy	4949 Coolidge Highway	Royal Oak	MI	Active
DSH230130AH	Child	DSH	Corewell Health William Beaumont University Hospital	Corewell Health William Beaumont University Hospital Cardiovascular Imaging - 39500 10 Mile Rd	39500 W 10 MILE RD	NOVI	MI	Active
DSH230130AJ	Child	DSH	Corewell Health William Beaumont University Hospital	Corewell Health William Beaumont University Hospital Heart & Vascular Center - 4600 Investment Dr	4600 Investment Drive	Troy	MI	Active
DSH230130AK	Child	DSH	Corewell Health William Beaumont University Hospital	Corewell Health William Beaumont University Hospital Cardiology - 16800 12 Mile Rd	16800 W 12 MILE RD	SOUTHFIELD	MI	Active
DSH230130AL	Child	DSH	Corewell Health William Beaumont University Hospital	Corewell Health William Beaumont University Hospital Heart & Vascular Center - 44344 Dequindre Rd	44344 DEQUINDRE RD	STERLING HEIGHTS	MI	Active
DSH230130AM	Child	DSH	Corewell Health William Beaumont University Hospital	BEAUMONT NORTHPOINTE HEART-BERKLEY - Cardiology	27901 WOODWARD AVE	BERKLEY	MI	Active
DSH230130AN	Child	DSH	Corewell Health William Beaumont University Hospital	Corewell Health William Beaumont University Hospital Gynecological Oncology - 3577 W 13 Mile Rd - Gyn Onc	3577 W. 13 Mile Rd	Royal Oak	MI	Active
DSH230130AP	Child	DSH	Corewell Health William Beaumont University Hospital	Corewell Health Transplant Evaluation Services - Kidney Transplant	3575 W. 13 Mile Rd	Royal Oak	MI	Active
DSH230130AQ	Child	DSH	Corewell Health William Beaumont University Hospital	Corewell Health William Beaumont University Hospital Hematology & Oncology - 3577 W 13 Mile Rd - HemOnc	3577 W 13 Mile Rd	Royal Oak	MI	Active
DSH230130AR	Child	DSH	Corewell Health William Beaumont University Hospital	Corewell Health William Beaumont University Hospital Urology Clinic - 3535 W 13 Mile Rd - Urology	3535 W 13 Mile Rd	Royal Oak	MI	Active
DSH230130B	Child	DSH	Corewell Health William Beaumont University Hospital	Corewell Health William Beaumont University Hospital Multidisciplinary Center - 3577 W 13 Mile Rd	3577 W 13 MILE RD	ROYAL OAK	MI	Active
DSH230130C	Child	DSH	Corewell Health William Beaumont University Hospital	Corewell Health William Beaumont University Hospital Obstetrics & Gynecology - 3535 W 13 Mile Rd	3535 West 13 Mile Road	Royal Oak	MI	Active
DSH230130D	Child	DSH	Corewell Health William Beaumont University Hospital	Corewell Health William Beaumont University Hospital Neurology - 3555 W 13 Mile Rd	3555 West 13 Mile Road	Royal Oak	MI	Active
DSH230130E	Child	DSH	Corewell Health William Beaumont University Hospital	Corewell Health William Beaumont University Hospital Pediatric Gastroenterology - 3535 W 13 Mile Rd	3535 West 13 Mile Rd	Royal Oak	MI	Active
DSH230130F	Child	DSH	Corewell Health William Beaumont University Hospital	BEAUMONT INFECTIOUS DISEASE - Infectious Disease	3535 W 13 MILE RD	ROYAL OAK	MI	Active
DSH230130G	Child	DSH	Corewell Health William Beaumont University Hospital	Corewell Health William Beaumont University Hospital Pediatric & Adult Neurosurgery - 3555 W 13 Mile Rd	3555 West 13 Mile Rd	Royal Oak	MI	Active
DSH230130H	Child	DSH	WILLIAM BEAUMONT HOSPITAL- ROYAL OAK	BEAUMONT ASSOCIATES VAS & ENDO SURG - Vascular Services	4600 INVESTMENT DR	TROY	MI	Terminated
DSH230130J	Child	DSH	Corewell Health William Beaumont University Hospital	McBrien Pediatric Neurology - Pediatric Neurology	3555 West 13 Mile Rd	Royal Oak	MI	Active
DSH230130K	Child	DSH	Corewell Health William Beaumont University Hospital	Corewell Health William Beaumont University Hospital Skandalaris Family Center for Children with Cancer & Blood Disorders - 3571 W 13 Mile Rd	3571 W 13 MILE RD	ROYAL OAK	MI	Active
DSH230130L	Child	DSH	WILLIAM BEAUMONT HOSPITAL- ROYAL OAK	BEAUMONT SPECIALIST IN VASCULAR SUR - Vascular Surger	31700 TELEGRAPH RD	BINGHAM FARMS	MI	Terminated
DSH230130M	Child	DSH	Corewell Health William Beaumont University Hospital	Corewell Health William Beaumont University Hospital Hepatitis C Clinic - 3535 W 13 Mile Rd	3535 West 13 Mile Rd	Royal Oak	MI	Active
DSH230130N	Child	DSH	Corewell Health William Beaumont University Hospital	Northpointe Health Center / Internal Medicine - Internal Medicine	1949 West 12 Mile Road	Berkley	MI	Active
DSH230130P	Child	DSH	Corewell Health William Beaumont University Hospital	Corewell Health William Beaumont University Hospital Kidney & Hypertension Center - 3535 W 13 Mile Rd	3535 West 13 Mile Rd	Royal Oak	MI	Active
DSH230130Q	Child	DSH	Corewell Health William Beaumont University Hospital	Corewell Health William Beaumont University Hospital Florence & Richard McBrien Pediatric Epilepsy - 3555 W 13 Mile Rd	3555 W 13 MILE RD	ROYAL OAK	MI	Active
DSH230130R	Child	DSH	Corewell Health William Beaumont University Hospital	Corewell Health William Beaumont University Hospital Outpatient Clinics - 3535 W 13 Mile Rd	3535 West 13 Mile Rd	Royal Oak	MI	Active
DSH230130S	Child	DSH	Corewell Health William Beaumont University Hospital	Corewell Health William Beaumont University Hospital Pediatric Rheumatology - 3535 W 13 Mile Rd	3535 West 13 Mile Rd	Royal Oak	MI	Active
DSH230130T	Child	DSH	Corewell Health William Beaumont University Hospital	Corewell Health William Beaumont University Hospital General Ear Nose & Throat - 3555 W 13 Mile Rd	3555 West 13 Mile Rd	Royal Oak	MI	Active
DSH230130U	Child	DSH	Corewell Health William Beaumont University Hospital	Corewell Health William Beaumont University Hospital Geriatric Assessment Clinic - 1949 12 Mile Rd	1949 W. Twelve Mile Rd	Berkley	MI	Active
DSH230130V	Child	DSH	Corewell Health William Beaumont University Hospital	Corewell Health William Beaumont University Hospital Pediatric Endocrinology - 3535 W 13 Mile Rd	3535 West 13 Mile Rd	Royal Oak	MI	Active
DSH230130W	Child	DSH	Corewell Health William Beaumont University Hospital	Corewell Health William Beaumont University Hospital Cardiovascular - 29645 14 Mile Rd	29645 W 14 MILE RD	FARMINGTON HILLS	MI	Active
DSH230130X	Child	DSH	Corewell Health William Beaumont University Hospital	Corewell Health William Beaumont University Hospital Pulmonary & Sleep Medicine - 3535 W 13 Mile Rd	3535 W 13 MILE RD	ROYAL OAK	MI	Active
DSH230130Y	Child	DSH	Corewell Health William Beaumont University Hospital	Beaumont Medical Center-West Bloomfield / Outpatient Surgery - Surgery	6900 Orchard Lake Road	West Bloomfield	MI	Active
DSH230130Z	Child	DSH	Corewell Health William Beaumont University Hospital	Corewell Health William Beaumont University Hospital Plastic & Reconstructive Surgery - 3555 W 13 Mile Rd	3555 West 13 Mile Rd	Royal Oak	MI	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Profile Change Request	Dalal, Hardik SVP, Finance CHW Corewell Health 3127710810	Dalal, Hardik SVP, Finance & System-wide Pharmacy Finance Corewell Health 3127710810	2/24/2025 6:26 AM
Contacts	Signed By	Update	Profile Change Request	Dalal, Hardik SVP, Finance CHW Corewell Health 3127710810	Dalal, Hardik SVP, Finance & System-wide Pharmacy Finance Corewell Health 3127710810	2/24/2025 6:26 AM
Details	Entity Name	Update	Recertification	WILLIAM BEAUMONT HOSPITAL- ROYAL OAK	Corewell Health William Beaumont University Hospital	8/27/2024 9:40 AM
Details	Last Recertification Date	Update	Recertification		8/21/2024 7:33:12 AM	8/21/2024 7:33 AM
Details	Entity Subname	Update	Recertification	Beaumont Medical Center-Royal Oak / Beaumount OB/GYN Generalist - OB/GYN - OB/GYN	Corewell Health William Beaumont University Hospital Obstetrics & Gynecology - 3535 W 13 Mile Rd	8/21/2024 7:33 AM
Details	State	Update		Approved	Active	4/1/2024 12:01 AM
Contacts	Signed By	Insert	New Registration		Dalal, Hardik SVP, Finance CHW Corewell Health 3127710810	2/5/2024 11:34 AM
Details	340B ID	Update	New Registration		DSH230130C	2/5/2024 11:34 AM
Details	Entity Subname	Update	New Registration	Beaumont Medical Center-Royal Oak / Beaumount OB/GYN Generalist - OB/GYN	Beaumont Medical Center-Royal Oak / Beaumount OB/GYN Generalist - OB/GYN - OB/GYN	2/5/2024 11:34 AM
Dates	Participating Approval Date	Update	New Registration		2/5/2024 11:34:50 AM	2/5/2024 11:34 AM
Details	State	Update	New Registration	Pending	Approved	2/5/2024 11:34 AM
Dates	Signed By Date	Update	New Registration		1/16/2024 2:45:29 PM	2/5/2024 11:34 AM
Dates	Start Date	Update	New Registration		4/1/2024 12:00:00 AM	2/5/2024 11:34 AM
Contacts	Primary Contact	Update	Profile Change Request	Schaible, Thomas 340B Pharmacy Manager Corewell Health 9475221169	Schaible, Thomas Mgr, Pharmacy CHE Corewell Health 9475221169	1/30/2024 8:36 AM
Addresses	Main Address	Insert	New Registration		3535 West 13 Mile Road Suite 329 Royal Oak, MI 48073	1/13/2024 1:19 PM
Addresses	Billing Address	Insert	New Registration		WILLIAM BEAUMONT HOSPITAL dba Beaumont Hospital - Royal Oak 3601 WEST 13 MILE ROAD ROYAL OAK, MI 48073	1/13/2024 1:19 PM
Addresses	Shipping Address	Insert	New Registration		WILLIAM BEAUMONT HOSPITAL dba Beaumont Hospital - Royal Oak 3601 WEST 13 MILE ROAD ROYAL OAK, MI 48073	1/13/2024 1:19 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1689653305	1/13/2024 1:19 PM
Medicaid Billing	NPI: State	Insert	New Registration		MI	1/13/2024 1:19 PM
Contacts	Authorizing Official	Insert	New Registration		Dalal, Hardik SVP, Finance CHW Corewell Health 3127710810	1/13/2024 1:19 PM
Contacts	Primary Contact	Insert	New Registration		Schaible, Thomas 340B Pharmacy Manager Corewell Health 9475221169	1/13/2024 1:19 PM
Details	Assistance Received From Date	Insert	New Registration			1/13/2024 1:19 PM
Details	Assistance Received To Date	Insert	New Registration			1/13/2024 1:19 PM
Details	Last Recertification Date	Insert	New Registration			1/13/2024 1:19 PM
Details	Grant Number	Insert	New Registration			1/13/2024 1:19 PM
Details	340B ID	Insert	New Registration			1/13/2024 1:19 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/13/2024 1:19 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/13/2024 1:19 PM
Details	Medicare Provider Number	Insert	New Registration		230130	1/13/2024 1:19 PM
Details	Entity Name	Insert	New Registration		WILLIAM BEAUMONT HOSPITAL- ROYAL OAK	1/13/2024 1:19 PM
Details	NOFO Number	Insert	New Registration			1/13/2024 1:19 PM
Details	Program Code	Insert	New Registration		DSH	1/13/2024 1:19 PM
Details	Entity Subname	Insert	New Registration		Beaumont Medical Center-Royal Oak / Beaumount OB/GYN Generalist - OB/GYN	1/13/2024 1:19 PM
Dates	Participating Approval Date	Insert	New Registration			1/13/2024 1:19 PM
Details	State	Insert	New Registration		Pending	1/13/2024 1:19 PM
Dates	Registration Date	Insert	New Registration		1/13/2024 1:19:39 PM	1/13/2024 1:19 PM
Dates	Signed By Date	Insert	New Registration			1/13/2024 1:19 PM
Dates	Start Date	Insert	New Registration			1/13/2024 1:19 PM
Terminations	Termination Comments	Insert	New Registration			1/13/2024 1:19 PM
Terminations	Termination Date	Insert	New Registration			1/13/2024 1:19 PM
Terminations	Termination Effective Date	Insert	New Registration			1/13/2024 1:19 PM
Terminations	Termination Reason	Insert	New Registration			1/13/2024 1:19 PM