Covered Entity Details

DSH230297G Barbara Ann Karmanos Cancer Hospital DBA Karmanos Cancer Center (Active) - information as of 5/2/2025 10:35:40 PM

Main Details

Name

Barbara Ann Karmanos Cancer Hospital DBA Karmanos Cancer Center

Subdivision Name

Weisberg Cancer Center - Weisberg MRI

Type

Disproportionate Share Hospital

Rural

340B ID

DSH230297G

Medicare Provider Number

230297

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

4/11/2018

Participating Start Date

7/1/2018

Participating Approval Date

5/11/2018

Last Recertification Date

8/27/2024

Contacts

Authorizing Official

Karmanos Cancer Center
Regina Doxtader, VP-Chief Financial Officer
(313) 576-8657

Primary Contact

Karmanos Cancer Center
Surender Kanaparthi, VP-Chief Pharmacy Officer
(313) 576-8809

Addresses

Street Address

31995 Northwestern Hwy
Farmington Hills, MI 48334

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	4830315	1013319201,1316900277,1962114744
IN	4830315	1962114744,1013319201,1316900277
OH	2858091	1962114744,1013319201,1316900277

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
DSH230297A	Child	DSH	Barbara Ann Karmanos Cancer Hospital DBA Karmanos Cancer Center	WEISBERG CANCER CENTER	31995 NORTHWESTERN HWY	FARMINGTON HILLS	MI	Active
DSH230297C	Child	DSH	Barbara Ann Karmanos Cancer Hospital DBA Karmanos Cancer Center	Weisberg Cancer Center - Weisberg Clinic	31995 Northwestern Hwy	Farmington Hills	MI	Active
DSH230297D	Child	DSH	Barbara Ann Karmanos Cancer Hospital DBA Karmanos Cancer Center	Weisberg Cancer Center - Weisberg CT Scan	31995 Northwestern Hwy	Farmington Hills	MI	Active
DSH230297E	Child	DSH	Barbara Ann Karmanos Cancer Hospital DBA Karmanos Cancer Center	Weisberg Cancer Center - Weisberg IV Therapy	31995 Northwestern Hwy	Farmington Hills	MI	Active
DSH230297F	Child	DSH	Barbara Ann Karmanos Cancer Hospital DBA Karmanos Cancer Center	Weisberg Cancer Center - Weisberg Diagnostic Radiology	31995 Northwestern Hwy	Farmington Hills	MI	Active
DSH230297G	Child	DSH	Barbara Ann Karmanos Cancer Hospital DBA Karmanos Cancer Center	Weisberg Cancer Center - Weisberg MRI	31995 Northwestern Hwy	Farmington Hills	MI	Active
DSH230297H	Child	DSH	Barbara Ann Karmanos Cancer Hospital DBA Karmanos Cancer Center	Weisberg Cancer Center - WEISBERG RADIATION ONCOLOGY CENTER	31995 Northwestern Hwy	Farmington Hills	MI	Active
DSH230297J	Child	DSH	Barbara Ann Karmanos Cancer Hospital DBA Karmanos Cancer Center	Weisberg Cancer Center - Weisberg PET/CT	31995 Northwestern Hwy	Farmington Hills	MI	Active
DSH230297K	Child	DSH	Barbara Ann Karmanos Cancer Hospital DBA Karmanos Cancer Center	Weisberg Cancer Center - Weisberg Ultrasound	31995 Northwestern Hwy	Farmington Hills	MI	Active
DSH230297L	Child	DSH	Barbara Ann Karmanos Cancer Hospital DBA Karmanos Cancer Center	Karmanos Cancer Center - PET Center	3901 Beaubien Boulevard	Detroit	MI	Active
DSH230297M	Child	DSH	Barbara Ann Karmanos Cancer Hospital DBA Karmanos Cancer Center	WEISBERG CANCER CENTER - Weisberg Cancer Center - Interventional Radiology	31995 NORTHWESTERN HWY	FARMINGTON HILLS	MI	Active
DSH230297N	Child	DSH	Barbara Ann Karmanos Cancer Hospital DBA Karmanos Cancer Center	WEISBERG CANCER CENTER - Weisberg Cancer Center - Nuclear Medicine	31995 NORTHWESTERN HWY	FARMINGTON HILLS	MI	Active
DSH230297P	Child	DSH	Barbara Ann Karmanos Cancer Hospital DBA Karmanos Cancer Center	WEISBERG CANCER CENTER - Weisberg Cancer Center - Special Procedure	31995 NORTHWESTERN HWY	FARMINGTON HILLS	MI	Active
DSH230297Q	Child	DSH	Barbara Ann Karmanos Cancer Hospital DBA Karmanos Cancer Center	WEISBERG CANCER CENTER - Weisberg Cancer Center - Bone Density	31995 NORTHWESTERN HWY	FARMINGTON HILLS	MI	Active
DSH230297R	Child	DSH	Barbara Ann Karmanos Cancer Hospital DBA Karmanos Cancer Center	KARMANOS CANCER CENTER - Infusion Center - Roseville	30550 UTICA RD	ROSEVILLE	MI	Active
DSH230297S	Child	DSH	Barbara Ann Karmanos Cancer Hospital DBA Karmanos Cancer Center	KARMANOS CANCER CENTER - Oncology Clinic - Roseville	30550 UTICA RD	ROSEVILLE	MI	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Group Change Request	SMITH, STEPHEN T. CHIEF PHARMACY OFFICER Karmanos Cancer Center 3135768809	Kanaparthi, Surender VP-Chief Pharmacy Officer Karmanos Cancer Center 3135768809	9/9/2024 4:36 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1013319201	9/6/2024 2:30 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	9/6/2024 2:30 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1316900277	9/6/2024 2:30 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	9/6/2024 2:30 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1013319201	9/6/2024 2:30 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IN	9/6/2024 2:30 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1316900277	9/6/2024 2:30 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IN	9/6/2024 2:30 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	40-4830315 (IN)		9/5/2024 7:31 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	40-4830315 (OH)		9/5/2024 7:31 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	9/5/2024 7:31 AM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		4830315	9/5/2024 7:31 AM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		MI	9/5/2024 7:31 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	9/5/2024 7:31 AM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		4830315	9/5/2024 7:31 AM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		IN	9/5/2024 7:31 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	9/5/2024 7:31 AM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		2858091	9/5/2024 7:31 AM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		OH	9/5/2024 7:31 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	40-4830315 (MI)		9/5/2024 7:31 AM
Details	Last Recertification Date	Update	Recertification	8/28/2023 11:33:37 AM	8/27/2024 1:23:46 PM	8/27/2024 1:23 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	8/31/2023 12:36 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		40-4830315	8/31/2023 12:36 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		IN	8/31/2023 12:36 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	8/31/2023 12:36 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		40-4830315	8/31/2023 12:36 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		OH	8/31/2023 12:36 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1962114744	8/31/2023 12:36 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MI	8/31/2023 12:36 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1962114744	8/31/2023 12:36 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	8/31/2023 12:36 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1962114744	8/31/2023 12:36 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IN	8/31/2023 12:36 PM
Details	Last Recertification Date	Update	Recertification	9/13/2022 12:44:03 PM	8/28/2023 11:33:37 AM	8/28/2023 11:33 AM
Contacts	Authorizing Official	Update	Change Request	Gamble, Brian Chief Financial Officer Karmanos Cancer Center 3135768935	Doxtader, Regina VP-Chief Financial Officer Karmanos Cancer Center 3135768657	3/6/2023 5:25 PM
Details	Last Recertification Date	Update	Recertification	9/8/2021 1:34:20 PM	9/13/2022 12:44:03 PM	9/13/2022 12:44 PM
Details	Last Recertification Date	Update	Recertification	9/9/2020 2:10:41 PM	9/8/2021 1:34:20 PM	9/8/2021 1:34 PM
Contacts	Primary Contact	Update	Profile Change Request	SMITH, STEPHEN T. DIRECTOR, PHARMACY Karmanos Cancer Center 3135768809	SMITH, STEPHEN T. CHIEF PHARMACY OFFICER Karmanos Cancer Center 3135768809	12/18/2020 8:31 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1013319201	9/9/2020 2:10 PM
Medicaid Billing	NPI: State	Insert	Recertification		MI	9/9/2020 2:10 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1316900277	9/9/2020 2:10 PM
Medicaid Billing	NPI: State	Insert	Recertification		MI	9/9/2020 2:10 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1316900277 ( )		9/9/2020 2:10 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1013319201 ( )		9/9/2020 2:10 PM
Details	Last Recertification Date	Update	Recertification	8/22/2019 8:06:29 AM	9/9/2020 2:10:41 PM	9/9/2020 2:10 PM
Details	Entity Subname	Update	Recertification	Weisberg Cancer Treatment Center - Weisberg MRI	Weisberg Cancer Center - Weisberg MRI	9/9/2020 2:10 PM
Details	Entity Name	Update	Recertification	KARMANOS CANCER CENTER	Barbara Ann Karmanos Cancer Hospital DBA Karmanos Cancer Center	9/9/2020 2:09 PM
Details	Last Recertification Date	Update	Recertification	8/21/2018 10:10:35 AM	8/22/2019 8:06:29 AM	8/22/2019 8:06 AM
Details	Last Recertification Date	Update	Recertification		8/21/2018 10:10:35 AM	8/21/2018 10:10 AM
Details	State	Update		Approved	Active	7/1/2018 12:00 AM
Contacts	Signed By	Insert	New Registration		Gamble, Brian Chief Financial Officer Karmanos Cancer Center 3135768935	5/11/2018 6:51 AM
Details	340B ID	Update	New Registration		DSH230297G	5/11/2018 6:51 AM
Details	Entity Subname	Update	New Registration	Weisberg Cancer Treatment Center	Weisberg Cancer Treatment Center - Weisberg MRI	5/11/2018 6:51 AM
Dates	Participating Approval Date	Update	New Registration		5/11/2018 6:51:38 AM	5/11/2018 6:51 AM
Details	State	Update	New Registration	Pending	Approved	5/11/2018 6:51 AM
Dates	Signed By Date	Update	New Registration		4/12/2018 7:46:59 AM	5/11/2018 6:51 AM
Dates	Start Date	Update	New Registration		7/1/2018 12:00:00 AM	5/11/2018 6:51 AM
Addresses	Main Address	Insert	New Registration		31995 Northwestern Hwy Farmington Hills, MI 48334	4/11/2018 1:53 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/11/2018 1:53 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		40-4830315	4/11/2018 1:53 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		MI	4/11/2018 1:53 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1316900277	4/11/2018 1:53 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1013319201	4/11/2018 1:53 PM
Contacts	Authorizing Official	Insert	New Registration		Gamble, Brian Chief Financial Officer Karmanos Cancer Center 3135768935	4/11/2018 1:53 PM
Contacts	Primary Contact	Insert	New Registration		SMITH, STEPHEN T. DIRECTOR, PHARMACY Karmanos Cancer Center 3135768809	4/11/2018 1:53 PM
Details	Last Recertification Date	Insert	New Registration			4/11/2018 1:53 PM
Details	Grant Number	Insert	New Registration			4/11/2018 1:53 PM
Details	340B ID	Insert	New Registration			4/11/2018 1:53 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/11/2018 1:53 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/11/2018 1:53 PM
Details	Medicare Provider Number	Insert	New Registration		230297	4/11/2018 1:53 PM
Details	Entity Name	Insert	New Registration		KARMANOS CANCER CENTER	4/11/2018 1:53 PM
Details	Program Code	Insert	New Registration		DSH	4/11/2018 1:53 PM
Details	Entity Subname	Insert	New Registration		Weisberg Cancer Treatment Center	4/11/2018 1:53 PM
Dates	Participating Approval Date	Insert	New Registration			4/11/2018 1:53 PM
Details	State	Insert	New Registration		Pending	4/11/2018 1:53 PM
Dates	Registration Date	Insert	New Registration		4/11/2018 1:53:28 PM	4/11/2018 1:53 PM
Dates	Signed By Date	Insert	New Registration			4/11/2018 1:53 PM
Dates	Start Date	Insert	New Registration			4/11/2018 1:53 PM
Terminations	Termination Comments	Insert	New Registration			4/11/2018 1:53 PM
Terminations	Termination Date	Insert	New Registration			4/11/2018 1:53 PM
Terminations	Termination Effective Date	Insert	New Registration			4/11/2018 1:53 PM
Terminations	Termination Reason	Insert	New Registration			4/11/2018 1:53 PM