340B Drug Pricing Program Database


DSH230165H Ascension St. John Hospital DBA Henry Ford St. John Hospital (Active) - information as of 4/30/2025 10:55:08 PM

Main Details
Ascension St. John Hospital DBA Henry Ford St. John Hospital
ST. JOHN HOSPITAL MACOMB TOWNSHIP CAMPUS / SJHMC 23 Mile Surgery Center
Disproportionate Share Hospital
Yes
DSH230165H
230165


Additional Details
Active
7/5/2016
10/1/2016
8/19/2016
8/15/2024

Contacts

Henry Ford Hospital
Doug Clark, SVP - Corporate Finance
(313) 874-5446

Henry Ford Hospital
Alexander Mansour, 340B Compliance Officer
(248) 723-0020

Addresses

17700 23 MILE ROAD
MACOMB, MI 48044

Same as Street Address


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
8/19/16 Participated starting 4/1/2006, terminated 7/1/2016, reinstated 10/1/2016.08/19/2016
7/18/2007-NEW NAME & ADDRESS. WAS: ROMEO PLANK OUTPATIENT SATELLITE 46591 ROMEO PLANK RD MACOMB TOWNSHIP, MI 4804407/18/2007
7/18/2007-NEW NAME & ADDRESS. WAS: ROMEO PLANK OUTPATIENT SATELLITE 46591 ROMEO PLANK RD MACOMB TOWNSHIP, MI 4804407/18/2007
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
MI51719871023088168
Shipping Addresses

ASCENSION ST. JOHN HOSPITAL
ASCENSION ST. JOHN HOSPITAL HEALTH CENTER AT 23 MILE
.(AUTOMATED DEVICE) 17700 23 MILE RD
MACOMB, MI 48044
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailAFFILIATED HEALTH SERVICES, INC.ASCENSION RX 1307 17900 23 MILE RD
STE 104
MACOMBMI4804404/01/200904/01/2009 07/01/201608/19/2016
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
DSH230165AChildDSHST JOHN HOSPITAL & MEDICAL CENTERPROFESSIONAL BUILDING #122151 MOROSS ROADDETROITMITerminated
DSH230165AAChildDSHST JOHN HOSPITAL & MEDICAL CENTERSt John Internal Medicine Residency Clinic/St John Hospital and Medical Center7633 East Jefferson Ave Suite 170DetroitMITerminated
DSH230165ABChildDSHST JOHN HOSPITAL & MEDICAL CENTERRomeo Plank Family Practice/St John Hospital and Medical Center46591 Romeo Plank Road Suite 200MacombMITerminated
DSH230165ACChildDSHAscension St. John Hospital DBA Henry Ford St. John HospitalMasonic Medical Center/St John Hospital and Medical Center21099 MasonicSt Clair ShoresMIActive
DSH230165ADChildDSHAscension St. John Hospital DBA Henry Ford St. John HospitalInternal Medicine Specialty Center/St John Hospital and Medical Center22201 Moross Road Suite 50DetroitMIActive
DSH230165AEChildDSHAscension St. John Hospital DBA Henry Ford St. John HospitalPerinatology/St John Hospital and Medical Center22151 Moross Road Suite 320DetroitMIActive
DSH230165AFChildDSHAscension St. John Hospital DBA Henry Ford St. John HospitalPediatric Surgery/St John Hospital and Medical Center22151 Moross Road Suite 209DetroitMIActive
DSH230165AGChildDSHAscension St. John Hospital DBA Henry Ford St. John HospitalChildren's Center Clinic/St John Hospital and Medical Center22201 Moross Road Suite 70DetroitMIActive
DSH230165AHChildDSHAscension St. John Hospital DBA Henry Ford St. John HospitalSt John Rheumatology 22151 Moross, PBI, Suite 214DetroitMIActive
DSH230165AJChildDSHST JOHN HOSPITAL & MEDICAL CENTERSt John Podiatry Clinic22151 Moross Road Suite 335 PB1DetroitMITerminated
DSH230165AKChildDSHAscension St. John Hospital DBA Henry Ford St. John HospitalSt John Rheumatology17900 23 Mile Road Suite 203Macomb TownshipMIActive
DSH230165ALChildDSHST JOHN HOSPITAL & MEDICAL CENTERSt John Surgery Clinic22101 Moross Road Suite 214 PB1DetroitMITerminated
DSH230165AMChildDSHAscension St. John Hospital DBA Henry Ford St. John HospitalSt John Transplant Center22201 Moross Road Suite 480 PB2DetroitMIActive
DSH230165ANChildDSHAscension St. John Hospital DBA Henry Ford St. John HospitalSt John Hospital and Medical Center Anesthesia / Pain Management 21000 East Twelve Mile Road Suite 100St Clair ShoresMIActive
DSH230165APChildDSHST JOHN HOSPITAL & MEDICAL CENTER Children's Center / 23 Mile Road17900 23 MILE RD SUITE 303MACOMBMITerminated
DSH230165AQChildDSHST JOHN HOSPITAL & MEDICAL CENTER Internal Medicine / 23 Mile Road Clinic17900 23 Mile Road Suite 303Macomb TownshipMITerminated
DSH230165ARChildDSHAscension St. John Hospital DBA Henry Ford St. John HospitalROCHESTER HILLS MEDICAL ONCOLOGY CL / SJH&MC Rochester Hills Medical Oncology Clinic Suite C1901 STAR BATT ROADROCHESTER HILLSMIActive
DSH230165ASChildDSHAscension St. John Hospital DBA Henry Ford St. John HospitalROCHESTER HILLS INFUSION / SJH&MC Rochester Hills Infusion 1901 STAR BATT ROADROCHESTER HILLSMIActive
DSH230165ATChildDSHAscension St. John Hospital DBA Henry Ford St. John HospitalSt John Providence Medical Center-Ralph J. Wilson Campus / St Clair Adult Medicine Specialists 17141 Kercheval AvenueGrosse PointeMIActive
DSH230165AUChildDSHAscension St. John Hospital DBA Henry Ford St. John HospitalGREAT LAKES CANCER MANAGEMENT19229 MACK AVE STE 24GROSSE POINTE WOODSMIActive
DSH230165AVChildDSHAscension St. John Hospital DBA Henry Ford St. John HospitalSJHMC- Pediatric Hematology/Oncology19229 Mack AveGrosse Pointe WoodsMIActive
DSH230165AWChildDSHAscension St. John Hospital DBA Henry Ford St. John HospitalST JOHN HEMATOLOGY AND ONCOLOGY/ST19229 MACK AVEGROSSE POINTE WOODSMIActive
DSH230165AXChildDSHAscension St. John Hospital DBA Henry Ford St. John HospitalSt John Gyn Oncology19229 Mack AveGrosse Pointe WoodsMIActive
DSH230165AYChildDSHST JOHN HOSPITAL & MEDICAL CENTERSJHMC-VINAY MALVYIA Gynecology Oncology22301 FOSTER WINTER DR 3SOUTHFIELDMITerminated
DSH230165AZChildDSHAscension St. John Hospital DBA Henry Ford St. John HospitalSJHMC Macomb Township 23 Mile Campus / SJHMC Emergency Room and Urgent Care 23 Mile Road17700 23 Mile Road Suite 150Macomb TownshipMIActive
DSH230165BChildDSHST JOHN HOSPITAL & MEDICAL CENTERPROFESSIONAL BUILDING II22201 MOROSS ROADDETROITMITerminated
DSH230165BAChildDSHAscension St. John Hospital DBA Henry Ford St. John HospitalSJHMC-NEWLAND MEDICAL ASSOC NOVI - Newland Medical Associates of Novi47601 GRAND RIVERNOVIMIActive
DSH230165BBChildDSHAscension St. John Hospital DBA Henry Ford St. John HospitalNEWLAND RHEUMATOLOGY - Newland Medical Associates Rheumatology22250 PROVIDENCE DRSOUTHFIELDMIActive
DSH230165BCChildDSHAscension St. John Hospital DBA Henry Ford St. John HospitalSJHMC-NEWLAND MED ASSOC SOUTHFIELD - St. John Newland Medical Associates of Southfield22301 FOSTER WINTER DR 2SOUTHFIELDMIActive
DSH230165BDChildDSHAscension St. John Hospital DBA Henry Ford St. John HospitalSJHMC-NEWLAND MED ASS BINGHAM FARMS - Newland Medical Associates of Bingham Farms31500 TELEGRAPH RD 225BINGHAM FARMSMIActive
DSH230165BEChildDSHAscension St. John Hospital DBA Henry Ford St. John HospitalGREAT LAKES CANCER MANAGEMENT SPECI - Great Lakes Cancer Management Specialists Clinic17900 23 MILE RDMACOMBMIActive
DSH230165BFChildDSHAscension St. John HospitalASSOCIATES IN INTERNAL MEDICINE - Associates In Internal Medicine18263 E 10 MILE RD STE CROSEVILLEMITerminated
DSH230165BGChildDSHAscension St. John Hospital DBA Henry Ford St. John HospitalWOUND AND HYPERBARIC CENTER SJHMC - Wound Care22151 MOROSS RDDETROITMIActive
DSH230165BHChildDSHAscension St. John Hospital DBA Henry Ford St. John HospitalGYNECOLOGIC ONCOLOGY - Gynecology Oncology22301 FOSTER WINTER DRSOUTHFIELDMIActive
DSH230165BJChildDSHAscension St. John Hospital DBA Henry Ford St. John HospitalHARPER FAMILY PRACTICE - HARPER FAMILY PRACTICE19901 E 10 MILE RDST CLAIR SHORESMIActive
DSH230165BKChildDSHAscension St. John Hospital DBA Henry Ford St. John HospitalWARREN FAMILY PHYSICIAN - Warren Family Physicians11270 E 13 MILE RDWARRENMIActive
DSH230165BLChildDSHAscension St. John Hospital DBA Henry Ford St. John HospitalPREMIER FAMILY PHYSICIANS - Premier Family Physicians24100 LITTLE MACKST CLAIR SHORESMIActive
DSH230165BMChildDSHAscension St. John Hospital DBA Henry Ford St. John HospitalST JOHN HOSPITAL AND MEDICAL CENTER - St John Wellness FM18303 E 10 MILE RD STE 500ROSEVILLEMIActive
DSH230165CChildDSHAscension St. John Hospital DBA Henry Ford St. John HospitalVAN ELSLANDER CANCER CENTER19229 MACK AVENUEGROSSE POINTE WOODSMIActive
DSH230165DChildDSHAscension St. John Hospital DBA Henry Ford St. John HospitalINTERNAL MEDICINE CLINIC19251 MACK AVENUEGROSSE POINTE WOODSMIActive
DSH230165EChildDSHAscension St. John Hospital DBA Henry Ford St. John HospitalOUTPATIENT SURGERY CENTER / SJHMC Surgery Center 21000 TWELVE MILE ROADST CLAIR SHORESMIActive
DSH230165FChildDSHST JOHN HOSPITAL & MEDICAL CENTEROUTPATIENT SATELLITE20952 E TWELVE MILE ROADST CLAIR SHORESMITerminated
DSH230165GChildDSHAscension St. John Hospital DBA Henry Ford St. John HospitalFAMILY MEDICAL CENTER OUTPATIENT SATELLITE24911 LITTLE MACKST CLAIR SHORESMIActive
DSH230165HChildDSHAscension St. John Hospital DBA Henry Ford St. John HospitalST. JOHN HOSPITAL MACOMB TOWNSHIP CAMPUS / SJHMC 23 Mile Surgery Center17700 23 MILE ROADMACOMBMIActive
DSH230165MChildDSHST JOHN HOSPITAL & MEDICAL CENTERMEDICAL PAVILION TWO7633 E. JEFFERSONDETROITMITerminated
DSH230165NChildDSHAscension St. John Hospital DBA Henry Ford St. John HospitalPROFESSIONAL OFFICE BUILDING - 23 MILE17900 23 MILE ROADMACOMBMIActive
DSH230165PChildDSHAscension St. John HospitalST JOHN HOSPITAL- WARREN CANCER AND INFUSION CENTER11885 12 MILE ROADWARRENMITerminated
DSH230165QChildDSHAscension St. John Hospital DBA Henry Ford St. John HospitalST. JOHN HOSPITAL & MEDICAL CENTER- WEBBER CANCER CENTER AND INFUSION CENTER11800 E 12 MILE ROADWARRENMIActive
DSH230165RChildDSHAscension St. John Hospital DBA Henry Ford St. John HospitalSt. John Hospital and Medical Center-Providence Cancer Center22301 Foster Winter DriveSouthfieldMIActive
DSH230165SChildDSHAscension St. John Hospital DBA Henry Ford St. John HospitalSt John Hospital and Medical Center - Assarian Cancer Center47601 Grand River Ave.NoviMIActive
DSH230165TChildDSHAscension St. John Hospital DBA Henry Ford St. John HospitalNewland Medical Associates31500 TelegraphBingham FarmsMIActive
DSH230165UChildDSHST JOHN HOSPITAL & MEDICAL CENTERCornerstone Romeo Family Practice64580 Van DykeWashingtonMITerminated
DSH230165WChildDSHAscension St. John Hospital DBA Henry Ford St. John HospitalSt. John Hospital and Medical Center Doctors Park4014 River RoadEast ChinaMIActive
DSH230165XChildDSHAscension St. John Hospital DBA Henry Ford St. John HospitalOB GYN Clinic/St John Hospital and Medical Center22201 Moross Road Suite 370DetroitMIActive
DSH230165YChildDSHAscension St. John Hospital DBA Henry Ford St. John HospitalOB GYN Faculty Clinic/St John Hospital and Medical Center22151 Moross Road Suite 313DetroitMIActive
DSH230165ZChildDSHAscension St. John HospitalDr. Hadesman Internal Medicine/St John Hospital and Medical Center7633 East Jefferson Ave Suite 290DetroitMITerminated
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
AddressesShipping AddressInsertChange Request ASCENSION ST. JOHN HOSPITAL ASCENSION ST. JOHN HOSPITAL HEALTH CENTER AT 23 MILE .(AUTOMATED DEVICE) 17700 23 MILE RD MACOMB, MI 480442/12/2025 10:36 AM
ContactsPrimary ContactUpdateGroup Change RequestFiser, Kelsey 340B Program Director Ascension Rx 6152225190Mansour, Alexander 340B Compliance Officer Henry Ford Hospital 24872300201/28/2025 11:25 AM
DetailsEntity NameUpdateChange RequestAscension St. John HospitalAscension St. John Hospital DBA Henry Ford St. John Hospital12/30/2024 7:30 AM
ContactsAuthorizing OfficialUpdateChange RequestMcCullough, Michael CFO Ascension Michigan 5867530653Clark, Doug SVP - Corporate Finance Henry Ford Hospital 313874544610/10/2024 8:13 AM
DetailsLast Recertification DateUpdateRecertification8/15/2023 5:57:21 AM8/15/2024 11:50:41 AM8/15/2024 11:50 AM
ContactsPrimary ContactUpdateGroup Change RequestBeldyga, Lyndy 340b manager Ascension Health 9899078000Fiser, Kelsey 340B Program Director Ascension Rx 61522251901/8/2024 12:06 PM
DetailsLast Recertification DateUpdateRecertification8/30/2022 11:13:11 AM8/15/2023 5:57:21 AM8/15/2023 5:57 AM
ContactsPrimary ContactUpdateGroup Change RequestFiser, Kelsey 340B Program Director Ascension Rx 6152225190Beldyga, Lyndy 340b manager Ascension Health 98990780008/3/2023 8:44 AM
ContactsAuthorizing OfficialUpdateChange RequestWinner, Douglas CFO, Acute Care Operations St John Providence 5867530662McCullough, Michael CFO Ascension Michigan 58675306536/5/2023 7:37 AM
DetailsLast Recertification DateUpdateRecertification9/13/2021 11:00:38 AM8/30/2022 11:13:11 AM8/30/2022 11:13 AM
ContactsPrimary ContactUpdatePC Change RequestBlake, Gary Director Pharmacy St John Hospital and Medical Center 3133433763Fiser, Kelsey 340B Program Director Ascension Rx 61522251903/28/2022 7:00 AM
DetailsLast Recertification DateUpdateRecertification9/14/2020 7:11:15 PM9/13/2021 11:00:38 AM9/13/2021 11:00 AM
Medicaid BillingNPI: NumberInsertRecertification 10230881689/14/2020 7:11 PM
Medicaid BillingNPI: StateInsertRecertification MI9/14/2020 7:11 PM
Medicaid BillingNPI: NumberDeleteRecertification1023088168 ( ) 9/14/2020 7:11 PM
DetailsLast Recertification DateUpdateRecertification8/21/2019 2:25:07 PM9/14/2020 7:11:15 PM9/14/2020 7:11 PM
DetailsEntity NameUpdateChange RequestST JOHN HOSPITAL & MEDICAL CENTERAscension St. John Hospital8/12/2020 7:17 AM
DetailsLast Recertification DateUpdateRecertification9/11/2018 2:14:45 PM8/21/2019 2:25:07 PM8/21/2019 2:25 PM
DetailsLast Recertification DateUpdateRecertification12/5/2017 2:41:49 PM9/11/2018 2:14:45 PM9/11/2018 2:14 PM
DetailsLast Recertification DateUpdateRecertification 12/5/2017 2:41:49 PM12/5/2017 2:41 PM
ContactsPrimary ContactUpdate Blake, Gary Director Pharmacy 3133433763Blake, Gary Director Pharmacy St John Hospital and Medical Center 313343376311/17/2017 1:26 PM
ContactsAuthorizing OfficialInsertAO Change Request Winner, Douglas CFO, Acute Care Operations St John Providence 586753066210/31/2017 3:15 PM
ContactsSigned ByUpdate MARX, TOMASINE CHIEF FINANCIAL OFFICER 3133437676MARX, TOMASINE CHIEF FINANCIAL OFFICER St John Hospital and Medical Center 313343767610/20/2017 3:16 PM
ContactsPrimary ContactInsert  Blake, Gary Director Pharmacy 31334337637/25/2017 8:45 AM
ContactsSigned ByInsert  MARX, TOMASINE CHIEF FINANCIAL OFFICER 31334376767/25/2017 8:45 AM
AddressesMain AddressInsert   17700 23 MILE ROAD MACOMB, MI 480448/19/2016 2:15 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False8/19/2016 2:14 PM
Medicaid BillingMedicaid: NumberInsert  51719878/19/2016 2:14 PM
Medicaid BillingMedicaid: StateInsert  MI8/19/2016 2:14 PM
Medicaid BillingNPI: NumberInsert  10230881688/19/2016 2:14 PM
DetailsLast Recertification DateUpdate 8/31/2015 12:00:00 AM 8/19/2016 2:14 PM
DatesLast Date That 340B Drugs PurchasedUpdate 3/31/2016 12:00:00 AM 8/19/2016 2:14 PM
DetailsEntity SubnameUpdate ST. JOHN HOSPITAL MACOMB TOWNSHIP CAMPUSST. JOHN HOSPITAL MACOMB TOWNSHIP CAMPUS / SJHMC 23 Mile Surgery Center8/19/2016 2:14 PM
DatesParticipating Approval DateUpdate 2/23/2006 12:00:00 AM8/19/2016 12:00:00 AM8/19/2016 2:14 PM
DetailsStateUpdate TerminatedActive8/19/2016 2:14 PM
DatesRegistration DateUpdate 2/22/2006 12:00:00 AM7/5/2016 12:00:00 AM8/19/2016 2:14 PM
DatesSigned By DateUpdate 2/20/2006 12:00:00 AM7/5/2016 12:00:00 AM8/19/2016 2:14 PM
DatesStart DateUpdate 4/1/2006 12:00:00 AM10/1/2016 12:00:00 AM8/19/2016 2:14 PM
TerminationsTermination CommentsUpdate cleaning up the database by removing the original child sites that related to buildings 8/19/2016 2:14 PM
TerminationsTermination DateUpdate 7/1/2016 12:00:00 AM 8/19/2016 2:14 PM
TerminationsTermination Effective DateUpdate 3/31/2016 12:00:00 AM 8/19/2016 2:14 PM
TerminationsTermination ReasonUpdate Site closure 8/19/2016 2:14 PM
DetailsComments PublicInsert  8/19/16 Participated starting 4/1/2006, terminated 7/1/2016, reinstated 10/1/2016.8/19/2016 2:14 PM
DatesLast Date That 340B Drugs PurchasedUpdate  3/31/2016 12:00:00 AM4/20/2016 3:26 PM
DetailsStateUpdate ActiveTerminated4/20/2016 3:26 PM
TerminationsTermination CommentsUpdate  cleaning up the database by removing the original child sites that related to buildings4/20/2016 3:26 PM
TerminationsTermination DateUpdate  7/1/2016 12:00:00 AM4/20/2016 3:26 PM
TerminationsTermination Effective DateUpdate  3/31/2016 12:00:00 AM4/20/2016 3:26 PM
TerminationsTermination ReasonUpdate  Site closure4/20/2016 3:26 PM
DetailsLast Recertification DateUpdate 9/3/2014 12:00:00 AM8/31/2015 12:00:00 AM8/31/2015 9:54 AM
DetailsLast Recertification DateUpdate 9/11/2013 12:00:00 AM9/3/2014 12:00:00 AM9/3/2014 12:54 PM
DetailsLast Recertification DateUpdate 9/11/2013 1:34:56 PM9/11/2013 12:00:00 AM5/2/2014 12:16 PM
DetailsLast Recertification DateUpdate 7/1/2012 12:00:00 AM9/11/2013 1:34:56 PM9/11/2013 1:34 PM
DetailsLast Recertification DateUpdate  7/1/2012 12:00:00 AM5/3/2012 10:45 AM
DetailsLast Recertification DateInsert   7/18/2007 8:36 AM
DetailsGrant NumberInsert   7/18/2007 8:36 AM
Details340B IDInsert  DSH230165H7/18/2007 8:36 AM
DetailsIs Authorizing Official EHB DataInsert   7/18/2007 8:36 AM
DatesLast Date That 340B Drugs PurchasedInsert   7/18/2007 8:36 AM
DetailsMedicare Provider NumberInsert  2301657/18/2007 8:36 AM
DetailsEntity NameInsert  ST JOHN HOSPITAL & MEDICAL CENTER7/18/2007 8:36 AM
DetailsProgram CodeInsert  DSH7/18/2007 8:36 AM
DetailsEntity SubnameInsert  ST. JOHN HOSPITAL MACOMB TOWNSHIP CAMPUS7/18/2007 8:36 AM
DatesParticipating Approval DateInsert  2/23/2006 12:00:00 AM7/18/2007 8:36 AM
DetailsStateInsert  Active7/18/2007 8:36 AM
DatesRegistration DateInsert  2/22/2006 12:00:00 AM7/18/2007 8:36 AM
DatesSigned By DateInsert  2/20/2006 12:00:00 AM7/18/2007 8:36 AM
DatesStart DateInsert  4/1/2006 12:00:00 AM7/18/2007 8:36 AM
TerminationsTermination CommentsInsert   7/18/2007 8:36 AM
TerminationsTermination DateInsert   7/18/2007 8:36 AM
TerminationsTermination Effective DateInsert   7/18/2007 8:36 AM
TerminationsTermination ReasonInsert   7/18/2007 8:36 AM
DetailsComments PublicInsert  7/18/2007-NEW NAME & ADDRESS. WAS: ROMEO PLANK OUTPATIENT SATELLITE 46591 ROMEO PLANK RD MACOMB TOWNSHIP, MI 480447/18/2007 8:36 AM
DetailsComments PublicInsert  7/18/2007-NEW NAME & ADDRESS. WAS: ROMEO PLANK OUTPATIENT SATELLITE 46591 ROMEO PLANK RD MACOMB TOWNSHIP, MI 480447/18/2007 8:36 AM