Covered Entity Details

DSH230151L BOTSFORD HOSPITAL (Terminated) - information as of 5/20/2025 11:41:21 PM

Main Details

Name

BOTSFORD HOSPITAL

Subdivision Name

BOTSFORD GENERAL HOSPITAL - Botsford Heart Health Center

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH230151L

Medicare Provider Number

230151

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

1/15/2018

Participating Start Date

4/1/2018

Participating Approval Date

1/30/2018

Last Recertification Date

8/16/2018

Termination Date
Termination Reason

10/1/2018
Site closure

Contacts

Authorizing Official

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

Primary Contact

Beaumont Health
Scott Nastwold, Director, Pharmacy Services
(248) 471-8356

Addresses

Street Address

39475 LEWIS DR, STE 200
BOTSFORD HEART HEALTH CENTER
NOVI, MI 48377-2980

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	1336183367
		1336183367

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
DSH230151A	Child	DSH	Botsford General Hospital d/b/a Corewell Health Farmington Hills Hospital	BEAUMONT RHEUMATOLOGY ASSOCIATES (Dept# 730170) -Rheumatology Bone Densometer	28100 GRAND RIVER AVE	FARMINGTON HILLS	MI	Active
DSH230151AA	Child	DSH	Botsford General Hospital d/b/a Corewell Health Farmington Hills Hospital	Corewell Health Farmington Hills Hospital Imaging - 39000 W 7 Mile Rd	39000 W 7 MILE RD	LIVONIA	MI	Active
DSH230151AB	Child	DSH	Botsford General Hospital d/b/a Corewell Health Farmington Hills Hospital	Corewell Health Farmington Hills Hospital Breast Care Center - 39000 W 7 Mile Rd	39000 W 7 MILE RD	LIVONIA	MI	Active
DSH230151AC	Child	DSH	Botsford General Hospital d/b/a Corewell Health Farmington Hills Hospital	Corewell Health Farmington Hills Hospital Noninvasive Cardiology- 39000 W 7 Mile Rd	39000 W 7 MILE RD	LIVONIA	MI	Active
DSH230151AD	Child	DSH	Botsford General Hospital d/b/a Corewell Health Farmington Hills Hospital	Corewell Health Farmington Hills Hospital Infusion Center - 39000 W 7 Mile Rd	39000 W 7 MILE RD	LIVONIA	MI	Active
DSH230151C	Child	DSH	Botsford General Hospital d/b/a Corewell Health Farmington Hills Hospital	Corewell Health Farmington Hills Hospital Internal Medicine - 20317 Farmington Rd	20317 FARMINGTON RD	LIVONIA	MI	Active
DSH230151D	Child	DSH	Botsford General Hospital d/b/a Beaumont Hospital - Farmington Hills	BEAUMONT FAMILY MEDICINE-NOVI (Dept# 730047) -Botsford Family Medicine Ctr	39475 LEWIS DR	NOVI	MI	Terminated
DSH230151E	Child	DSH	Botsford General Hospital d/b/a Corewell Health Farmington Hills Hospital	Corewell Health Family Medicine - 32754 Grand River Ave	32754 GRAND RIVER AVE	FARMINGTON	MI	Active
DSH230151F	Child	DSH	Botsford General Hospital d/b/a Corewell Health Farmington Hills Hospital	BEAUMONT MEDICAL CENTER-REDFORD (Dept# 730116) -Botsford Medical Ctr Redford	15540 BEECH DALY RD	REDFORD	MI	Active
DSH230151G	Child	DSH	Botsford General Hospital d/b/a Corewell Health Farmington Hills Hospital	Corewell Health Farmington Hills Hospital Infusion Clinic - 44344 Dequindre Rd	44344 Dequindre	Sterling Heights	MI	Active
DSH230151H	Child	DSH	Botsford General Hospital d/b/a Corewell Health Farmington Hills Hospital	BEAUMONT HOSPITAL, FARMINGTON HILLS, INFUSION CENTER (Dept# 743015) -Infusion Center RO	3601 West Thirteen Mile Rd	Royal Oak	MI	Active
DSH230151J	Child	DSH	Botsford General Hospital d/b/a Corewell Health Farmington Hills Hospital	Corewell Health Farmington Hills Hospital Family Medicine - 28100 Grand River Ave	28100 GRAND RIVER AVE SUITE 313	FARMINGTON HILLS	MI	Active
DSH230151K	Child	DSH	Botsford General Hospital d/b/a Corewell Health Farmington Hills Hospital	Corewell Health Farmington Hills Hospital Cardiology - 28080 Grand River Ave	28080 GRAND RIVER AVE STE 306N	FARMINGTON HILLS	MI	Active
DSH230151L	Child	DSH	BOTSFORD HOSPITAL	BOTSFORD GENERAL HOSPITAL - Botsford Heart Health Center	39475 LEWIS DR, STE 200	NOVI	MI	Terminated
DSH230151M	Child	DSH	Botsford General Hospital d/b/a Beaumont Hospital - Farmington Hills	BEAUMONT INTERNAL MEDICINE ASSOCIATES-FARMINGTON HILLS (Dept# 730235) -Lemon Internal Medicine	28100 GRAND RIVER AVE STE 206	FARMINGTON HILLS	MI	Terminated
DSH230151N	Child	DSH	Botsford General Hospital d/b/a Corewell Health Farmington Hills Hospital	BEAUMONT HEART HEALTH CENTER-LIVONIA (Dept# 730077) -Botsford Heart Health Center	28711 8 MILE RD STE B	LIVONIA	MI	Active
DSH230151P	Child	DSH	Botsford General Hospital d/b/a Corewell Health Farmington Hills Hospital	Corewell Health Farmington Hills Hospital Family Medicine - 44130 W 12 Mile Rd	44130 W 12 MILE ROAD	NOVI	MI	Active
DSH230151Q	Child	DSH	Botsford General Hospital d/b/a Beaumont Hospital - Farmington Hills	BEAUMONT GYNECOLOGIC ONCOLOGY-NOVI (Dept# 730073) -Gynecologic Oncology	39475 LEWIS DR STE 270	NOVI	MI	Terminated
DSH230151R	Child	DSH	Botsford General Hospital d/b/a Corewell Health Farmington Hills Hospital	BEAUMONT PULMONARY & SLEEP MEDICINE CLINIC (Dept# 730168) -Botsford Pulmonary & Sleep Med - Sleep Clinic	28080 GRAND RIVER	FARMINGTON HILLS	MI	Active
DSH230151S	Child	DSH	Botsford General Hospital d/b/a Corewell Health Farmington Hills Hospital	Corewell Health Farmington Hills Hospital Vascular Surgery Clinic - 28100 Grand River Ave	28100 GRAND RIVER	FARMINGTON HILLS	MI	Active
DSH230151T	Child	DSH	Botsford General Hospital d/b/a Corewell Health Farmington Hills Hospital	Corewell Health Family Medicine – 27031 W Warren St.	27031 W WARREN	DEARBORN HEIGHTS	MI	Active
DSH230151U	Child	DSH	Botsford General Hospital d/b/a Corewell Health Farmington Hills Hospital	Corewell Health Internal Medicine - 27015 W Warren St	27015 W WARREN	DEARBORN HEIGHTS	MI	Active
DSH230151V	Child	DSH	Botsford General Hospital d/b/a Corewell Health Farmington Hills Hospital	BEAUMONT PODIATRY CLINIC (Dept# 730166) -Botsford Podiatry - Podiatry	28100 GRAND RIVER	FARMINGTON HILLS	MI	Active
DSH230151W	Child	DSH	Botsford General Hospital d/b/a Corewell Health Farmington Hills Hospital	Corewell Health Farmington Hills Hospital Family Medicine - 39000 W 7 Mile Rd	39000 W 7 MILE RD	LIVONIA	MI	Active
DSH230151X	Child	DSH	Botsford General Hospital d/b/a Corewell Health Farmington Hills Hospital	Corewell Health Farmington Hills Hospital Endocrinology Clinic - 28100 Grand River Ave	28100 Grand River	Farmington Hills	MI	Active
DSH230151Y	Child	DSH	Botsford General Hospital d/b/a Corewell Health Farmington Hills Hospital	BEAUMONT OT & PT LIVONIA - Physical Therapy Services	39000 W 7 MILE RD	LIVONIA	MI	Active
DSH230151Z	Child	DSH	Botsford General Hospital d/b/a Corewell Health Farmington Hills Hospital	Corewell Health Farmington Hills Hospital Emergency - 39000 W 7 Mile Rd	39000 W 7 MILE RD	LIVONIA	MI	Active

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	10/1/2018 12:05 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		10/1/2018 12:00:00 AM	9/28/2018 8:16 AM
Details	State	Update	Termination Request	Active	To Be Terminated	9/28/2018 8:16 AM
Terminations	Termination Date	Update	Termination Request		10/1/2018 12:00:00 AM	9/28/2018 8:16 AM
Terminations	Termination Effective Date	Update	Termination Request		10/1/2018 12:00:00 AM	9/28/2018 8:16 AM
Terminations	Termination Reason	Update	Termination Request		Site closure	9/28/2018 8:16 AM
Details	Last Recertification Date	Update	Recertification		8/16/2018 10:33:31 AM	8/16/2018 10:33 AM
Details	State	Update		Approved	Active	4/1/2018 12:00 AM
Contacts	Signed By	Insert	New Registration		Wilson, Carolyn Chief Operating Officer Beaumont Health 2482133338	1/30/2018 3:11 PM
Details	340B ID	Update	New Registration		DSH230151L	1/30/2018 3:11 PM
Details	Entity Subname	Update	New Registration	BOTSFORD GENERAL HOSPITAL	BOTSFORD GENERAL HOSPITAL - Botsford Heart Health Center	1/30/2018 3:11 PM
Dates	Participating Approval Date	Update	New Registration		1/30/2018 3:11:13 PM	1/30/2018 3:11 PM
Details	State	Update	New Registration	Pending	Approved	1/30/2018 3:11 PM
Dates	Signed By Date	Update	New Registration		1/15/2018 10:39:18 AM	1/30/2018 3:11 PM
Dates	Start Date	Update	New Registration		4/1/2018 12:00:00 AM	1/30/2018 3:11 PM
Addresses	Main Address	Insert	New Registration		39475 LEWIS DR, STE 200 BOTSFORD HEART HEALTH CENTER NOVI, MI 48377-2980	1/15/2018 10:30 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/15/2018 10:30 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1336183367	1/15/2018 10:30 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		MI	1/15/2018 10:30 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1336183367	1/15/2018 10:30 AM
Contacts	Primary Contact	Insert	New Registration		Nastwold, Scott Director, Pharmacy Services Beaumont Health 2484718356	1/15/2018 10:30 AM
Contacts	Authorizing Official	Insert	New Registration		Wilson, Carolyn Chief Operating Officer Beaumont Health 2482133338	1/15/2018 10:30 AM
Details	Last Recertification Date	Insert	New Registration			1/15/2018 10:30 AM
Details	Grant Number	Insert	New Registration			1/15/2018 10:30 AM
Details	340B ID	Insert	New Registration			1/15/2018 10:30 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/15/2018 10:30 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/15/2018 10:30 AM
Details	Medicare Provider Number	Insert	New Registration		230151	1/15/2018 10:30 AM
Details	Entity Name	Insert	New Registration		BOTSFORD HOSPITAL	1/15/2018 10:30 AM
Details	Program Code	Insert	New Registration		DSH	1/15/2018 10:30 AM
Details	Entity Subname	Insert	New Registration		BOTSFORD GENERAL HOSPITAL	1/15/2018 10:30 AM
Dates	Participating Approval Date	Insert	New Registration			1/15/2018 10:30 AM
Details	State	Insert	New Registration		Pending	1/15/2018 10:30 AM
Dates	Registration Date	Insert	New Registration		1/15/2018 10:30:13 AM	1/15/2018 10:30 AM
Dates	Signed By Date	Insert	New Registration			1/15/2018 10:30 AM
Dates	Start Date	Insert	New Registration			1/15/2018 10:30 AM
Terminations	Termination Comments	Insert	New Registration			1/15/2018 10:30 AM
Terminations	Termination Date	Insert	New Registration			1/15/2018 10:30 AM
Terminations	Termination Effective Date	Insert	New Registration			1/15/2018 10:30 AM
Terminations	Termination Reason	Insert	New Registration			1/15/2018 10:30 AM