Covered Entity Details

RRC230130-06 WILLIAM BEAUMONT HOSPITAL - ROYAL OA (Terminated) - information as of 6/26/2025 12:25:17 AM

Main Details

Name

WILLIAM BEAUMONT HOSPITAL - ROYAL OA

Subdivision Name

Northpointe Health Center / Cardology Services

Type

Rural Referral Center

Rural

Yes

340B ID

RRC230130-06

Medicare Provider Number

230130

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

1/17/2017

Participating Start Date

4/1/2017

Participating Approval Date

3/11/2017

Last Recertification Date

11/29/2017

Termination Date
Termination Reason

4/1/2018
Site closure

Contacts

Authorizing Official

Beaumont Health
Carolyn Wilson, Chief Operating Officer
(947) 522-3338

Primary Contact

Beaumont Hospital
David Bach, Pharmacy Director
(248) 898-4305

Addresses

Street Address

1949 West 12 Mile Road
Suite 200
Berkley, MI 48072

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?
No

Shipping Addresses

Same as Street Address

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
RRC230130-01	Child	RRC	WILLIAM BEAUMONT HOSPITAL dba Beaumont Hospital - Royal Oak	Beaumont Outpatient Service Building / Vascular Services	4600 Investment Drive	Troy	MI	Terminated
RRC230130-02	Child	RRC	WILLIAM BEAUMONT HOSPITAL dba Beaumont Hospital - Royal Oak	Beaumont Outpatient Service Building / Cardiology	4600 Investment Drive	Troy	MI	Terminated
RRC230130-03	Child	RRC	WILLIAM BEAUMONT HOSPITAL - ROYAL OA	Beaumont Northpointe Cardiology-Berkley / Sleep Evaluation	27901 Woodward Ave.,	Berkley	MI	Terminated
RRC230130-04	Child	RRC	WILLIAM BEAUMONT HOSPITAL dba Beaumont Hospital - Royal Oak	Beaumont Northpointe Cardiology-Berkley / Cardiology	27901 Woodward Ave.,	Berkley	MI	Terminated
RRC230130-05	Child	RRC	WILLIAM BEAUMONT HOSPITAL dba Beaumont Hospital - Royal Oak	Northpointe Health Center / Internal Medicine	1949 West 12 Mile Road	Berkley	MI	Terminated
RRC230130-06	Child	RRC	WILLIAM BEAUMONT HOSPITAL - ROYAL OA	Northpointe Health Center / Cardology Services	1949 West 12 Mile Road	Berkley	MI	Terminated
RRC230130-07	Child	RRC	WILLIAM BEAUMONT HOSPITAL-ROYAL OAK	Beaumont Sleep Evaluation Services-Southfield	16310 12 Mile Rd	Southfield	MI	Terminated
RRC230130-08	Child	RRC	WILLIAM BEAUMONT HOSPITAL dba Beaumont Hospital - Royal Oak	Cancer Treatment Center / CTC Procedure	3577 West 13 Mile Road	Royal Oak	MI	Terminated
RRC230130-09	Child	RRC	WILLIAM BEAUMONT HOSPITAL dba Beaumont Hospital - Royal Oak	Beaumont Medical Center-West Bloomfield / Outpatient Surgery	6900 Orchard Lake Road	West Bloomfield	MI	Terminated
RRC230130-10	Child	RRC	WILLIAM BEAUMONT HOSPITAL	Beaumont Medical Center-West Bloomfield / Urgent Care	6900 Orchard Lake Road	West Bloomfield	MI	Terminated
RRC230130-11	Child	RRC	WILLIAM BEAUMONT HOSPITAL dba Beaumont Hospital - Royal Oak	Beaumont Medical Center-West Bloomfield / Vascular Services	6900 Orchard Lake Road	West Bloomfield	MI	Terminated
RRC230130-12	Child	RRC	WILLIAM BEAUMONT HOSPITAL dba Beaumont Hospital - Royal Oak	Beaumont Medical Center-West Bloomfield / Cardiology	6900 Orchard Lake Road	West Bloomfield	MI	Terminated
RRC230130-13	Child	RRC	WILLIAM BEAUMONT HOSPITAL dba Beaumont Hospital - Royal Oak	Beaumont Health Center / Vascular Services	4949 Coolidge Highway	Royal Oak	MI	Terminated
RRC230130-14	Child	RRC	WILLIAM BEAUMONT HOSPITAL dba Beaumont Hospital - Royal Oak	Beaumont Health Center / Pain Services	4949 Coolidge Highway	Royal Oak	MI	Terminated
RRC230130-15	Child	RRC	WILLIAM BEAUMONT HOSPITAL-ROYAL OAK	Beaumont Health Center / Hyperbaric Medicine	4949 Coolidge Highway	Royal Oak	MI	Terminated
RRC230130-16	Child	RRC	WILLIAM BEAUMONT HOSPITAL dba Beaumont Hospital - Royal Oak	Beaumont Medical Center-Royal Oak / Outpatient Clinic	3535 West 13 Mile Road	Royal Oak	MI	Terminated
RRC230130-17	Child	RRC	WILLIAM BEAUMONT HOSPITAL dba Beaumont Hospital - Royal Oak	Beaumont Medical Center-Royal Oak / Geriatric Evaluation Clinic	1949 W. Twelve Mile Rd	Berkley	MI	Terminated
RRC230130-18	Child	RRC	WILLIAM BEAUMONT HOSPITAL - ROYAL OA	Western Wayne Heart	17940 Farmington Road	Livonia	MI	Terminated
RRC230130-19	Child	RRC	WILLIAM BEAUMONT HOSPITAL-ROYAL OAK	Beaumont Academic Heart & Vascular	5100 Gateway Centre	Flint	MI	Terminated
RRC230130-20	Child	RRC	WILLIAM BEAUMONT HOSPITAL dba Beaumont Hospital - Royal Oak	Specialist in Vascular Surgery	31700 Telegraph Road	Bingham Farms	MI	Terminated
RRC230130-21	Child	RRC	WILLIAM BEAUMONT HOSPITAL dba Beaumont Hospital - Royal Oak	Beaumont Michigan Heart Group Troy	4550 Investment Drive	Troy	MI	Terminated
RRC230130-22	Child	RRC	WILLIAM BEAUMONT HOSPITAL dba Beaumont Hospital - Royal Oak	Beaumont Michigan Heart Group-Macomb	15959 Hall Road	Macomb	MI	Terminated
RRC230130-23	Child	RRC	WILLIAM BEAUMONT HOSPITAL dba Beaumont Hospital - Royal Oak	Beaumont Michigan Heart Group Novi	39500 West 10 Mile Road	Novi	MI	Terminated
RRC230130-24	Child	RRC	WILLIAM BEAUMONT HOSPITAL dba Beaumont Hospital - Royal Oak	Beaumont Northpointe Cardiology-Sterling Heights	44344 Dequindre Road	Sterling Heights	MI	Terminated
RRC230130-25	Child	RRC	WILLIAM BEAUMONT HOSPITAL dba Beaumont Hospital - Royal Oak	NorthPointe Heart Center-Southfield	16800 12 Mile Road	Southfield	MI	Terminated
RRC230130-26	Child	RRC	WILLIAM BEAUMONT HOSPITAL - ROYAL OA	Northpoint Heart Center - Bloomfield	33200 West 14 Mile Road	West Bloomfeld	MI	Terminated
RRC230130-27	Child	RRC	WILLIAM BEAUMONT HOSPITAL dba Beaumont Hospital - Royal Oak	Beaumont Cardiovascular Specialists	29645 W. 14 Mile Road	Farmington Hills	MI	Terminated
RRC230130-28	Child	RRC	WILLIAM BEAUMONT HOSPITAL - ROYAL OA	Cancer Treatment Center / Surgical Procedures	3577 West 13 Mile Road	Royal Oak	MI	Terminated
RRC230130-29	Child	RRC	WILLIAM BEAUMONT HOSPITAL	Imaging Center / Comprehensive Breast Center	3581 West 13 Mile Road	Royal Oak	MI	Terminated
RRC230130-30	Child	RRC	WILLIAM BEAUMONT HOSPITAL - ROYAL OA	Beaumont Opthalmology Procedure Suites	31157 Woodward Avenue	Royal Oak	MI	Terminated
RRC230130-31	Child	RRC	WILLIAM BEAUMONT HOSPITAL-ROYAL OAK	Beaumont Dialysis Center-Berkley	2624 11 Mile Road	Berkley	MI	Terminated
RRC230130-32	Child	RRC	WILLIAM BEAUMONT HOSPITAL-ROYAL OAK	Beaumont Dialysis Hazel Park	23231 John R. Road	Hazel Park	MI	Terminated
RRC230130-33	Child	RRC	WILLIAM BEAUMONT HOSPITAL dba Beaumont Hospital - Royal Oak	Beaumont Health Center / Cardiology	4949 Coolidge Highway	Royal Oak	MI	Terminated
RRC230130-34	Child	RRC	WILLIAM BEAUMONT HOSPITAL dba Beaumont Hospital - Royal Oak	Skandalaris Family Center for Children with Cancer and Blood Disorders	3571 West 13 Mile Road	Royal Oak	MI	Terminated
RRC230130-35	Child	RRC	WILLIAM BEAUMONT HOSPITAL dba Beaumont Hospital - Royal Oak	Beaumont Neuroscience Clinics/ Pediatric and Adult ENT	3555 West 13 Mile Rd	Royal Oak	MI	Terminated
RRC230130-36	Child	RRC	WILLIAM BEAUMONT HOSPITAL dba Beaumont Hospital - Royal Oak	Beaumont Medical Center - Royal Oak/Pedicatrics Sub-specialty Clinic - Pediatrics Sub-speciality Clinic	3535 West 13 Mile Rd	Royal Oak	MI	Terminated
RRC230130-37	Child	RRC	WILLIAM BEAUMONT HOSPITAL dba Beaumont Hospital - Royal Oak	Beaumont Florence and Richard McBrien Pediatric Neuroscience Center AKA McBrien Pediatric Epilepsy	3555 West 13 Mile Rd	Royal Oak	MI	Terminated
RRC230130-38	Child	RRC	WILLIAM BEAUMONT HOSPITAL dba Beaumont Hospital - Royal Oak	Beaumont Florence and Richard McBrien Pediatric Neuroscience Center AKA McBrien Pediatric Neurology	3555 West 13 Mile Rd	Royal Oak	MI	Terminated
RRC230130-39	Child	RRC	WILLIAM BEAUMONT HOSPITAL dba Beaumont Hospital - Royal Oak	Beaumont Medical Center - Royal Oak/Peds - Peds	3535 West 13 Mile Rd	Royal Oak	MI	Terminated
RRC230130-40	Child	RRC	WILLIAM BEAUMONT HOSPITAL dba Beaumont Hospital - Royal Oak	Beaumont Medical Center - Royal Oak/Infectious Disease - Infectious Disease	3535 West 13 Mile Rd	Royal Oak	MI	Terminated
RRC230130-41	Child	RRC	WILLIAM BEAUMONT HOSPITAL dba Beaumont Hospital - Royal Oak	Beaumont Medical Center - Royal Oak/Clinical Services/Infectious Disease - Clinical Services/Infectious Disease	3535 West 13 Mile Rd	Royal Oak	MI	Terminated
RRC230130-42	Child	RRC	WILLIAM BEAUMONT HOSPITAL dba Beaumont Hospital - Royal Oak	Beaumont Medical Center - Royal Oak/Internal Medicine - Internal Medicine	3535 West 13 Mile Rd	Royal Oak	MI	Terminated
RRC230130-43	Child	RRC	WILLIAM BEAUMONT HOSPITAL dba Beaumont Hospital - Royal Oak	Beaumont Medical Center - Royal Oak/Adult/non-Peds - Adult/non-Peds	3535 West 13 Mile Rd	Royal Oak	MI	Terminated
RRC230130-44	Child	RRC	WILLIAM BEAUMONT HOSPITAL dba Beaumont Hospital - Royal Oak	Beaumont Neuroscience Clinics/Beaumont Plastic & Reconstructive Surgery	3555 West 13 Mile Rd	Royal Oak	MI	Terminated
RRC230130-45	Child	RRC	WILLIAM BEAUMONT HOSPITAL dba Beaumont Hospital - Royal Oak	Beaumont Medical Center - Royal Oak/Eye Institute - Ophthamology	3535 West 13 Mile Road	Royal Oak	MI	Terminated
RRC230130-46	Child	RRC	WILLIAM BEAUMONT HOSPITAL dba Beaumont Hospital - Royal Oak	Beaumont Medical Center-Royal Oak / Beaumount OB/GYN Generalist - OB/GYN	3535 West 13 Mile Road	Royal Oak	MI	Terminated
RRC230130-47	Child	RRC	WILLIAM BEAUMONT HOSPITAL dba Beaumont Hospital - Royal Oak	Beaumont Internal Medicine Subspecialist - Royal Oak	3535 West 13 Mile Rd	Royal Oak	MI	Terminated
RRC230130-48	Child	RRC	WILLIAM BEAUMONT HOSPITAL dba Beaumont Hospital - Royal Oak	Beaumont Medical Center - Royal Oak/Beaumont Pediatric Gastroenterology - Pediatrics GI Specialty Clinic	3535 West 13 Mile Rd	Royal Oak	MI	Terminated
RRC230130-49	Child	RRC	WILLIAM BEAUMONT HOSPITAL dba Beaumont Hospital - Royal Oak	Beaumont Neuroscience Clinics/Beaumont Neurology - Neurology	3555 West 13 Mile Road	Royal Oak	MI	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
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
Contacts	Signed By	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	State	Update		To Be Terminated	Terminated	4/1/2018 12:00 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		4/30/2017 12:00:00 AM	2/12/2018 2:45 PM
Details	State	Update	Termination Request	Active	To Be Terminated	2/12/2018 2:45 PM
Terminations	Termination Date	Update	Termination Request		4/1/2018 12:00:00 AM	2/12/2018 2:45 PM
Terminations	Termination Effective Date	Update	Termination Request		5/1/2017 12:00:00 AM	2/12/2018 2:45 PM
Terminations	Termination Reason	Update	Termination Request		Site closure	2/12/2018 2:45 PM
Details	Last Recertification Date	Update	Recertification		11/29/2017 10:06:23 PM	11/29/2017 10:06 PM
Contacts	Primary Contact	Update		Bach, David Pharmacy Director 2488984305	Bach, David Pharmacy Director Beaumont Hospital 2488984305	10/20/2017 2:10 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	Signed By	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	Signed By	Insert			Wilson, Carolyn Chief Operating Officer 2482133338	7/3/2017 1:01 PM
Addresses	Main Address	Insert			1949 West 12 Mile Road Suite 200 Berkley, MI 48072	5/3/2017 1:22 PM
Contacts	Primary Contact	Insert			Bach, David Pharmacy Director 2488984305	5/3/2017 1:22 PM
Dates	Participating Approval Date	Update			3/11/2017 12:00:00 AM	3/11/2017 12:07 PM
Details	State	Update		Pending	Active	3/11/2017 12:07 PM
Dates	Start Date	Update			4/1/2017 12:00:00 AM	3/11/2017 12:07 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_75319	RRC230130-06	1/31/2017 9:55 AM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_75319	1/17/2017 4:20 PM
Details	Last Recertification Date	Insert				1/17/2017 4:20 PM
Details	Grant Number	Insert				1/17/2017 4:20 PM
Details	340B ID	Insert				1/17/2017 4:20 PM
Details	Is Authorizing Official EHB Data	Insert				1/17/2017 4:20 PM
Dates	Last Date That 340B Drugs Purchased	Insert				1/17/2017 4:20 PM
Details	Medicare Provider Number	Insert			230130	1/17/2017 4:20 PM
Details	Entity Name	Insert			WILLIAM BEAUMONT HOSPITAL - ROYAL OA	1/17/2017 4:20 PM
Details	Program Code	Insert			RRC	1/17/2017 4:20 PM
Details	Entity Subname	Insert			Northpointe Health Center / Cardology Services	1/17/2017 4:20 PM
Dates	Participating Approval Date	Insert				1/17/2017 4:20 PM
Details	State	Insert			Pending	1/17/2017 4:20 PM
Dates	Registration Date	Insert			1/17/2017 12:00:00 AM	1/17/2017 4:20 PM
Dates	Signed By Date	Insert			1/17/2017 12:00:00 AM	1/17/2017 4:20 PM
Dates	Start Date	Insert				1/17/2017 4:20 PM
Terminations	Termination Comments	Insert				1/17/2017 4:20 PM
Terminations	Termination Date	Insert				1/17/2017 4:20 PM
Terminations	Termination Effective Date	Insert				1/17/2017 4:20 PM
Terminations	Termination Reason	Insert				1/17/2017 4:20 PM