Covered Entity Details

DSH230020F Oakwood Healthcare, Inc. d/b/a Beaumont Hospital - Dearborn (Terminated) - information as of 5/12/2025 10:12:39 PM

Main Details

Name

Oakwood Healthcare, Inc. d/b/a Beaumont Hospital - Dearborn

Subdivision Name

Oakwood Hematology Oncology Center

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH230020F

Medicare Provider Number

230020

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

8/8/2012

Participating Start Date

10/1/2012

Participating Approval Date

8/23/2012

Last Recertification Date

8/30/2021

Termination Date
Termination Reason

1/1/2022
Site closure

Contacts

Authorizing Official

Beaumont Health
Lee Ann Odom, President, Shared Services
(947) 522-2653

Primary Contact

Oakwood
Neha Desai, Director, Pharmacy
(313) 593-7255 Ext: 37268

Addresses

Street Address

4900 Mercury Drive
Suite 100
Dearborn, MI 48126

Billing Address
Same as Street Address

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		1740230119

Shipping Addresses

Shipping Address 1

Oakwood Hospital and Medical Center
18101 Oakwood Blvd
Dept of Pharmacy
Dearborn, MI 48124

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
DSH230020A	Child	DSH	OAKWOOD HOSPITAL & MEDICAL CENTER (OHMC)	Oakwood Breast Care Center	18100 Oakwood Blvd	Dearborn	MI	Terminated
DSH230020B	Child	DSH	OAKWOOD HOSPITAL & MEDICAL CENTER (OHMC)	Outpatient Imaging Center	Oakwood Medical Park	Dearborn	MI	Terminated
DSH230020C	Child	DSH	OAKWOOD HOSPITAL & MEDICAL CENTER (OHMC)	Oakwood Imaging West	25045 Ford Rd	Dearborn	MI	Terminated
DSH230020D	Child	DSH	OAKWOOD HOSPITAL & MEDICAL CENTER (OHMC)	Oakwood Imaging Dearborn Town Center	4700 Schaefer Rd	Dearborn	MI	Terminated
DSH230020E	Child	DSH	Oakwood Healthcare, Inc. d/b/a Corewell Health Dearborn Hospital	Corewell Health Dearborn Hospital Hematology & Oncology - 19725 Allen Rd	19725 Allen Rd	Brownstown	MI	Active
DSH230020F	Child	DSH	Oakwood Healthcare, Inc. d/b/a Beaumont Hospital - Dearborn	Oakwood Hematology Oncology Center	4900 Mercury Drive	Dearborn	MI	Terminated
DSH230020H	Child	DSH	Oakwood Healthcare, Inc. d/b/a Corewell Health Dearborn Hospital	Corewell Health Dearborn Hospital Center for Exceptional Families - 18501 Rotunda Dr	18501 Rotunda Dr.	Dearborn	MI	Active
DSH230020J	Child	DSH	Oakwood Healthcare, Inc. d/b/a Beaumont Hospital - Dearborn	Beaumont Infectious Disease-Dearborn	18181 Oakwood Blvd	Dearborn	MI	Terminated
DSH230020K	Child	DSH	Oakwood Healthcare, Inc. d/b/a Corewell Health Dearborn Hospital	Corewell Health Dearborn Hospital Specialty Services Cardiology - 22060 Beech St	22060 BEECH ST 200	DEARBORN	MI	Active
DSH230020L	Child	DSH	Oakwood Healthcare, Inc. d/b/a Corewell Health Dearborn Hospital	Corewell Health Dearborn Hospital Health Center - Commons Dearborn	16351 ROTUNDA DR 168	DEARBORN	MI	Active
DSH230020M	Child	DSH	Oakwood Healthcare, Inc. d/b/a Corewell Health Dearborn Hospital	Corewell Health Dearborn Hospital Internal Medicine - 17000 Hubbard Drive	17000 Hubbard Drive	Dearborn	MI	Active
DSH230020N	Child	DSH	Oakwood Healthcare, Inc. d/b/a Beaumont Hospital - Dearborn	Beaumont Pediatrics-Dearborn	18181 OAKWOOD BLVD G101	DEARBORN	MI	Terminated
DSH230020P	Child	DSH	Oakwood Healthcare, Inc. d/b/a Corewell Health Dearborn Hospital	Corewell Health Internal Medicine - 4700 Schaefer Rd	4700 SCHAEFER RD 240	DEARBORN	MI	Active
DSH230020Q	Child	DSH	Oakwood Healthcare, Inc. d/b/a Beaumont Hospital - Dearborn	Beaumont Center for Hematology & Oncology - Dearborn/Dr. Signori's Office - Hematology/Oncology	4900 Mercury Drive	Dearborn	MI	Terminated
DSH230020R	Child	DSH	Oakwood Healthcare, Inc. d/b/a Beaumont Hospital - Dearborn	Beaumont Rheumatology - Dearborn	4700 Schaefer Rd	Dearborn	MI	Terminated
DSH230020S	Child	DSH	Oakwood Healthcare, Inc. d/b/a Corewell Health Dearborn Hospital	Corewell Health Dearborn Hospital Obstetrics & Gynecology - 4700 Schaefer Rd	4700 Schaefer Rd	Dearborn	MI	Active
DSH230020T	Child	DSH	Oakwood Healthcare, Inc. d/b/a Corewell Health Dearborn Hospital	Corewell Health Dearborn Hospital General and Bariatric Surgery - 18181 Oakwood Blvd	18181 Oakwood Blvd	Dearborn	MI	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	1/1/2022 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		12/3/2021 12:00:00 AM	12/9/2021 2:52 PM
Details	State	Update	Termination Request	Active	To Be Terminated	12/9/2021 2:52 PM
Terminations	Termination Date	Update	Termination Request		1/1/2022 12:00:00 AM	12/9/2021 2:52 PM
Terminations	Termination Effective Date	Update	Termination Request		12/3/2021 12:00:00 AM	12/9/2021 2:52 PM
Terminations	Termination Reason	Update	Termination Request		Site closure	12/9/2021 2:52 PM
Details	Last Recertification Date	Update	Recertification	8/31/2020 4:12:29 PM	8/30/2021 9:42:19 AM	8/30/2021 9:42 AM
Contacts	Authorizing Official	Update	AO Change Request	Wilson, Carolyn Chief Operating Officer Beaumont Health 9475223338	Odom, Lee Ann President, Shared Services Beaumont Health 9475222653	8/20/2021 3:33 PM
Medicaid Billing	NPI: State	Update	Recertification		MI	8/31/2020 4:12 PM
Details	Last Recertification Date	Update	Recertification	8/29/2019 8:54:08 AM	8/31/2020 4:12:29 PM	8/31/2020 4:12 PM
Contacts	Authorizing Official	Update	Profile Change Request	Wilson, Carolyn Chief Operating Officer Beaumont Health 2482133338	Wilson, Carolyn Chief Operating Officer Beaumont Health 9475223338	6/2/2020 8:31 AM
Details	Entity Name	Update	Change Request	OAKWOOD HOSPITAL & MEDICAL CENTER (OHMC)	Oakwood Healthcare, Inc. d/b/a Beaumont Hospital - Dearborn	12/4/2019 9:00 AM
Details	Last Recertification Date	Update	Recertification	8/16/2018 10:30:00 AM	8/29/2019 8:54:08 AM	8/29/2019 8:54 AM
Contacts	Primary Contact	Update	Recertification	Desai, Neha Director, Pharmacy Oakwood 3135937255	Desai, Neha Director, Pharmacy Oakwood 3135937255-37268	8/28/2019 2:14 PM
Details	Last Recertification Date	Update	Recertification	11/29/2017 3:51:26 PM	8/16/2018 10:30:00 AM	8/16/2018 10:30 AM
Addresses	Shipping Address	Insert	Recertification		Oakwood Hospital and Medical Center 18101 Oakwood Blvd Dept of Pharmacy Dearborn, MI 48124	11/29/2017 3:51 PM
Details	Last Recertification Date	Update	Recertification	8/31/2016 12:00:00 AM	11/29/2017 3:51:26 PM	11/29/2017 3:51 PM
Contacts	Primary Contact	Update		Desai, Neha Director, Pharmacy 3135937255	Desai, Neha Director, Pharmacy Oakwood 3135937255	10/12/2017 3:44 PM
Contacts	Authorizing Official	Update		Wilson, Carolyn Chief Operating Officer 2482133338	Wilson, Carolyn Chief Operating Officer Beaumont Health 2482133338	10/12/2017 10:32 AM
Contacts	Authorizing Official	Insert			Wilson, Carolyn Chief Operating Officer 2482133338	7/3/2017 1:01 PM
Contacts	Primary Contact	Update		Batkie, David Director of Pharmacy 3135937248	Desai, Neha Director, Pharmacy 3135937255	3/13/2017 5:28 PM
Contacts	Signed By	Insert			Welday, Douglas EVP of Operations 3139825948	3/13/2017 3:11 PM
Addresses	Main Address	Insert			4900 Mercury Drive Suite 100 Dearborn, MI 48126	3/13/2017 3:10 PM
Medicaid Billing	NPI: Number	Insert			1740230119	3/13/2017 3:10 PM
Details	Last Recertification Date	Update		8/28/2015 12:00:00 AM	8/31/2016 12:00:00 AM	8/31/2016 3:54 PM
Contacts	Primary Contact	Insert			Batkie, David Director of Pharmacy 3135937248	8/28/2015 3:32 PM
Details	Last Recertification Date	Update		9/3/2014 12:00:00 AM	8/28/2015 12:00:00 AM	8/28/2015 3:32 PM
Details	Last Recertification Date	Update		8/30/2013 1:08:25 PM	9/3/2014 12:00:00 AM	9/3/2014 12:51 PM
Details	Last Recertification Date	Update			8/30/2013 1:08:25 PM	8/30/2013 1:08 PM
Details	340B ID	Update		IS-DR-DSH230020F	DSH230020F	8/23/2012 12:50 PM
Dates	Participating Approval Date	Update			8/23/2012 12:00:00 AM	8/23/2012 12:50 PM
Details	State	Update		Pending	Active	8/23/2012 12:50 PM
Dates	Start Date	Update			10/1/2012 12:00:00 AM	8/23/2012 12:50 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG	IS-DR-DSH230020F	8/21/2012 1:32 PM
Details	Last Recertification Date	Insert				8/8/2012 10:11 AM
Details	Grant Number	Insert				8/8/2012 10:11 AM
Details	340B ID	Insert			OUTPATIENT_ONLINE_REG	8/8/2012 10:11 AM
Details	Is Authorizing Official EHB Data	Insert				8/8/2012 10:11 AM
Dates	Last Date That 340B Drugs Purchased	Insert				8/8/2012 10:11 AM
Details	Medicare Provider Number	Insert			230020	8/8/2012 10:11 AM
Details	Entity Name	Insert			OAKWOOD HOSPITAL & MEDICAL CENTER (OHMC)	8/8/2012 10:11 AM
Details	Program Code	Insert			DSH	8/8/2012 10:11 AM
Details	Entity Subname	Insert			Oakwood Hematology Oncology Center	8/8/2012 10:11 AM
Dates	Participating Approval Date	Insert				8/8/2012 10:11 AM
Details	State	Insert			Pending	8/8/2012 10:11 AM
Dates	Registration Date	Insert			8/8/2012 12:00:00 AM	8/8/2012 10:11 AM
Dates	Signed By Date	Insert			8/8/2012 12:00:00 AM	8/8/2012 10:11 AM
Dates	Start Date	Insert				8/8/2012 10:11 AM
Terminations	Termination Comments	Insert				8/8/2012 10:11 AM
Terminations	Termination Date	Insert				8/8/2012 10:11 AM
Terminations	Termination Effective Date	Insert				8/8/2012 10:11 AM
Terminations	Termination Reason	Insert				8/8/2012 10:11 AM