Covered Entity Details

DSH230089D WILLIAM BEAUMONT HOSPITAL D/B/A Corewell Health Beaumont Grosse Pointe Hospital (Terminated) - information as of 4/25/2025 5:37:01 PM

Main Details

Name

WILLIAM BEAUMONT HOSPITAL D/B/A Corewell Health Beaumont Grosse Pointe Hospital

Subdivision Name

BEAUMONT FAMILY MEDICINE-GROSSE POINTE

Type

Disproportionate Share Hospital

Rural

340B ID

DSH230089D

Medicare Provider Number

230089

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

1/14/2020

Participating Start Date

4/1/2020

Participating Approval Date

2/5/2020

Last Recertification Date

9/3/2024

Termination Date
Termination Reason

1/1/2025
Business decision by the Covered Entity

Contacts

Authorizing Official

Corewell Health
Hardik Dalal, SVP, Finance & System-wide Pharmacy Finance
(312) 771-0810

Primary Contact

Corewell Health
Thomas Schaible, Mgr, Pharmacy CHE
(947) 522-1169

Addresses

Street Address

16815 E Jefferson Ave
Ste 120
Grosse Pointe, MI 48230

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		1932396017

Shipping Addresses

Shipping Address 1

WILLIAM BEAUMONT HOSPITAL D/B/A BEAUMONT HOSPITAL - GROSSE POINTE
468 Cadieux Road
Grosse Pointe, MI 48230

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
DSH230089A	Child	DSH	WILLIAM BEAUMONT HOSPITAL D/B/A Corewell Health Beaumont Grosse Pointe Hospital	Corewell Health Beaumont Grosse Pointe Hospital Pain Management - 16815 E Jefferson Ave	16815 East Jefferson Ave.	Grosse Pointe	MI	Active
DSH230089B	Child	DSH	WILLIAM BEAUMONT HOSPITAL D/B/A Corewell Health Beaumont Grosse Pointe Hospital	Beaumont Grosse Pointe Infusion Center	21400 E. Eleven Mile Rd	St. Clair Shores	MI	Active
DSH230089C	Child	DSH	WILLIAM BEAUMONT HOSPITAL D/B/A Corewell Health Beaumont Grosse Pointe Hospital	Beaumont Vein Clinic - Grosse Pointe - RADIOLOGY-DIAGNOSTIC	87 Kercheval, Suite 100	Grosse Pointe	MI	Active
DSH230089D	Child	DSH	WILLIAM BEAUMONT HOSPITAL D/B/A Corewell Health Beaumont Grosse Pointe Hospital	BEAUMONT FAMILY MEDICINE-GROSSE POINTE	16815 E Jefferson Ave	Grosse Pointe	MI	Terminated
DSH230089E	Child	DSH	WILLIAM BEAUMONT HOSPITAL D/B/A Corewell Health Beaumont Grosse Pointe Hospital	Corewell Health Beaumont Grosse Pointe Hospital Rehabilitation - Lenox Twp	36555 26 MILE RD	LENOX	MI	Active
DSH230089F	Child	DSH	WILLIAM BEAUMONT HOSPITAL D/B/A Corewell Health Beaumont Grosse Pointe Hospital	Corewell Health Beaumont Grosse Pointe Hospital Radiation Oncology - Lenox Twp	36555 26 MILE RD	LENOX	MI	Active
DSH230089G	Child	DSH	WILLIAM BEAUMONT HOSPITAL D/B/A Corewell Health Beaumont Grosse Pointe Hospital	DIAGNOSTIC IMAGING-LENOX - MRI	36555 26 MILE RD	LENOX	MI	Active
DSH230089H	Child	DSH	WILLIAM BEAUMONT HOSPITAL D/B/A Corewell Health Beaumont Grosse Pointe Hospital	Corewell Health Beaumont Grosse Pointe Hospital Ultrasound - Lenox Twp	36555 26 MILE RD	LENOX	MI	Active
DSH230089J	Child	DSH	WILLIAM BEAUMONT HOSPITAL D/B/A Corewell Health Beaumont Grosse Pointe Hospital	Corewell Health Beaumont Grosse Pointe Hospital Emergency - Lenox Twp	36555 26 MILE RD	LENOX	MI	Active
DSH230089K	Child	DSH	WILLIAM BEAUMONT HOSPITAL D/B/A Corewell Health Beaumont Grosse Pointe Hospital	Corewell Health Beaumont Grosse Pointe Hospital Imaging - Lenox Twp	36555 26 MILE RD	LENOX	MI	Active
DSH230089L	Child	DSH	WILLIAM BEAUMONT HOSPITAL D/B/A Corewell Health Beaumont Grosse Pointe Hospital	DIAGNOSTIC IMAGING-LENOX - CT Scan	36555 26 MILE RD	LENOX	MI	Active
DSH230089M	Child	DSH	WILLIAM BEAUMONT HOSPITAL D/B/A Corewell Health Beaumont Grosse Pointe Hospital	Corewell Health Beaumont Grosse Pointe Hospital PET - Lenox Twp	36555 26 MILE RD	LENOX	MI	Active
DSH230089N	Child	DSH	WILLIAM BEAUMONT HOSPITAL D/B/A Corewell Health Beaumont Grosse Pointe Hospital	Corewell Health Beaumont Grosse Pointe Hospital Infusion - Lenox Twp	36555 26 MILE RD	LENOX	MI	Active
DSH230089P	Child	DSH	WILLIAM BEAUMONT HOSPITAL D/B/A Corewell Health Beaumont Grosse Pointe Hospital	DIAGNOSTIC MAMMOGRAPHY-LENOX - Mammography	36555 26 MILE RD	LENOX	MI	Active
DSH230089Q	Child	DSH	WILLIAM BEAUMONT HOSPITAL D/B/A Corewell Health Beaumont Grosse Pointe Hospital	Corewell Health Beaumont Grosse Pointe Hospital Noninvasive Cardiology - Lenox Twp	36555 26 MILE RD	LENOX	MI	Active
DSH230089R	Child	DSH	WILLIAM BEAUMONT HOSPITAL D/B/A Corewell Health Beaumont Grosse Pointe Hospital	Corewell Health Beaumont Grosse Pointe Hospital Pulmonary - Lenox Twp	36555 26 MILE RD	LENOX	MI	Active
DSH230089S	Child	DSH	WILLIAM BEAUMONT HOSPITAL D/B/A Corewell Health Beaumont Grosse Pointe Hospital	Corewell Health Beaumont Grosse Pointe Hospital Wound Treatment - 16815 E Jefferson Ave	16815 E. Jefferson Ave.	Grosse Pointe	MI	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Profile Change Request	Dalal, Hardik SVP, Finance CHW Corewell Health 3127710810	Dalal, Hardik SVP, Finance & System-wide Pharmacy Finance Corewell Health 3127710810	2/24/2025 6:26 AM
Details	State	Update		To Be Terminated	Terminated	1/1/2025 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		12/3/2024 12:00:00 AM	12/6/2024 10:56 AM
Details	State	Update	Termination Request	Active	To Be Terminated	12/6/2024 10:56 AM
Terminations	Termination Date	Update	Termination Request		1/1/2025 12:00:00 AM	12/6/2024 10:56 AM
Terminations	Termination Effective Date	Update	Termination Request		12/3/2024 12:00:00 AM	12/6/2024 10:56 AM
Terminations	Termination Reason	Update	Termination Request		Business decision by the Covered Entity	12/6/2024 10:56 AM
Details	Last Recertification Date	Update	Recertification	8/21/2023 2:30:51 PM	9/3/2024 2:04:03 PM	9/3/2024 2:04 PM
Details	Entity Name	Update	Recertification	WILLIAM BEAUMONT HOSPITAL D/B/A BEAUMONT HOSPITAL - GROSSE POINTE	WILLIAM BEAUMONT HOSPITAL D/B/A Corewell Health Beaumont Grosse Pointe Hospital	8/21/2024 7:25 AM
Contacts	Primary Contact	Update	Profile Change Request	Schaible, Thomas 340B Pharmacy Manager Corewell Health 9475221169	Schaible, Thomas Mgr, Pharmacy CHE Corewell Health 9475221169	1/30/2024 8:36 AM
Contacts	Primary Contact	Update	PC Change Request	Schaible, Thomas Manager 340B Pharmacy Beaumont Hospital, Grosse Pointe 9475221169	Schaible, Thomas 340B Pharmacy Manager Corewell Health 9475221169	1/10/2024 12:37 PM
Contacts	Authorizing Official	Update	AO Change Request	Susick, Nancy Ann COO Beaumont Health 9475223349	Dalal, Hardik SVP, Finance CHW Corewell Health 3127710810	12/13/2023 7:55 AM
Details	Last Recertification Date	Update	Recertification	8/29/2022 2:41:43 PM	8/21/2023 2:30:51 PM	8/21/2023 2:30 PM
Addresses	Main Address	Update	Change Request	21400 ELEVEN MILE RD ST CLAIR SHORES, MI 48081-1566	16815 E Jefferson Ave Ste 120 Grosse Pointe, MI 48230	4/25/2023 11:43 AM
Details	Entity Subname	Update	Change Request	BEAUMONT FAMILY MED CTR-ST CLAIR SH - Family Medicine	BEAUMONT FAMILY MEDICINE-GROSSE POINTE	4/25/2023 11:43 AM
Contacts	Authorizing Official	Update	AO Change Request	Odom, Lee Ann President, Shared Services Beaumont Health 9475222653	Susick, Nancy Ann COO Beaumont Health 9475223349	10/10/2022 11:03 AM
Details	Last Recertification Date	Update	Recertification	8/30/2021 9:34:51 AM	8/29/2022 2:41:43 PM	8/29/2022 2:41 PM
Details	Last Recertification Date	Update	Recertification	8/31/2020 4:10:07 PM	8/30/2021 9:34:51 AM	8/30/2021 9:34 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 3:31 PM
Medicaid Billing	NPI: State	Update	Recertification		MI	8/31/2020 4:10 PM
Details	Last Recertification Date	Update	Recertification		8/31/2020 4:10:07 PM	8/31/2020 4:10 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
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		Approved	Active	4/1/2020 12:05 AM
Contacts	Signed By	Insert	New Registration		Wilson, Carolyn Chief Operating Officer Beaumont Health 2482133338	2/5/2020 6:13 AM
Details	340B ID	Update	New Registration		DSH230089D	2/5/2020 6:13 AM
Details	Entity Name	Update	New Registration	BEAUMONT HOSPITAL GROSSE POINTE	WILLIAM BEAUMONT HOSPITAL D/B/A BEAUMONT HOSPITAL - GROSSE POINTE	2/5/2020 6:13 AM
Details	Entity Subname	Update	New Registration	BEAUMONT FAMILY MED CTR-ST CLAIR SH	BEAUMONT FAMILY MED CTR-ST CLAIR SH - Family Medicine	2/5/2020 6:13 AM
Dates	Participating Approval Date	Update	New Registration		2/5/2020 6:13:14 AM	2/5/2020 6:13 AM
Details	State	Update	New Registration	Pending	Approved	2/5/2020 6:13 AM
Dates	Signed By Date	Update	New Registration		1/14/2020 2:28:17 PM	2/5/2020 6:13 AM
Dates	Start Date	Update	New Registration		4/1/2020 12:00:00 AM	2/5/2020 6:13 AM
Addresses	Main Address	Insert	New Registration		21400 ELEVEN MILE RD ST CLAIR SHORES, MI 48081-1566	1/14/2020 10:14 AM
Addresses	Shipping Address	Insert	New Registration		WILLIAM BEAUMONT HOSPITAL D/B/A BEAUMONT HOSPITAL - GROSSE POINTE 468 Cadieux Road Grosse Pointe, MI 48230	1/14/2020 10:14 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1932396017	1/14/2020 10:14 AM
Contacts	Authorizing Official	Insert	New Registration		Wilson, Carolyn Chief Operating Officer Beaumont Health 2482133338	1/14/2020 10:14 AM
Contacts	Primary Contact	Insert	New Registration		Schaible, Thomas Manager 340B Pharmacy Beaumont Hospital, Grosse Pointe 9475221169	1/14/2020 10:14 AM
Details	Last Recertification Date	Insert	New Registration			1/14/2020 10:14 AM
Details	Grant Number	Insert	New Registration			1/14/2020 10:14 AM
Details	340B ID	Insert	New Registration			1/14/2020 10:14 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/14/2020 10:14 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/14/2020 10:14 AM
Details	Medicare Provider Number	Insert	New Registration		230089	1/14/2020 10:14 AM
Details	Entity Name	Insert	New Registration		BEAUMONT HOSPITAL GROSSE POINTE	1/14/2020 10:14 AM
Details	Program Code	Insert	New Registration		DSH	1/14/2020 10:14 AM
Details	Entity Subname	Insert	New Registration		BEAUMONT FAMILY MED CTR-ST CLAIR SH	1/14/2020 10:14 AM
Dates	Participating Approval Date	Insert	New Registration			1/14/2020 10:14 AM
Details	State	Insert	New Registration		Pending	1/14/2020 10:14 AM
Dates	Registration Date	Insert	New Registration		1/14/2020 10:14:20 AM	1/14/2020 10:14 AM
Dates	Signed By Date	Insert	New Registration			1/14/2020 10:14 AM
Dates	Start Date	Insert	New Registration			1/14/2020 10:14 AM
Terminations	Termination Comments	Insert	New Registration			1/14/2020 10:14 AM
Terminations	Termination Date	Insert	New Registration			1/14/2020 10:14 AM
Terminations	Termination Effective Date	Insert	New Registration			1/14/2020 10:14 AM
Terminations	Termination Reason	Insert	New Registration			1/14/2020 10:14 AM