Covered Entity Details

DSH230089K WILLIAM BEAUMONT HOSPITAL D/B/A Corewell Health Beaumont Grosse Pointe Hospital (Active) - information as of 4/25/2025 8:30:56 PM

Main Details

Name

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

Subdivision Name

Corewell Health Beaumont Grosse Pointe Hospital Imaging - Lenox Twp

Type

Disproportionate Share Hospital

Rural

340B ID

DSH230089K

Medicare Provider Number

230089

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/9/2023

Participating Start Date

4/1/2023

Participating Approval Date

1/23/2023

Last Recertification Date

9/5/2024

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

36555 26 MILE RD
STE 1400
LENOX, MI 48048-3186

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

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
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	Last Recertification Date	Update	Recertification	8/21/2023 1:53:01 PM	9/5/2024 8:23:31 AM	9/5/2024 8:23 AM
Details	Entity Subname	Update	Recertification	DIAGNOSTIC IMAGING-LENOX - General Imaging	Corewell Health Beaumont Grosse Pointe Hospital Imaging - Lenox Twp	9/5/2024 8:23 AM
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		8/21/2023 1:53:01 PM	8/21/2023 1:53 PM
Details	State	Update		Approved	Active	4/1/2023 12:01 AM
Contacts	Signed By	Insert	New Registration		Susick, Nancy Ann COO Beaumont Health 9475223349	1/23/2023 2:40 PM
Details	340B ID	Update	New Registration		DSH230089K	1/23/2023 2:40 PM
Details	Entity Name	Update	New Registration	BEAUMONT HEALTH - GROSSE POINTE	WILLIAM BEAUMONT HOSPITAL D/B/A BEAUMONT HOSPITAL - GROSSE POINTE	1/23/2023 2:40 PM
Details	Entity Subname	Update	New Registration	DIAGNOSTIC IMAGING-LENOX	DIAGNOSTIC IMAGING-LENOX - General Imaging	1/23/2023 2:40 PM
Dates	Participating Approval Date	Update	New Registration		1/23/2023 2:40:57 PM	1/23/2023 2:40 PM
Details	State	Update	New Registration	Pending	Approved	1/23/2023 2:40 PM
Dates	Signed By Date	Update	New Registration		1/9/2023 3:15:18 PM	1/23/2023 2:40 PM
Dates	Start Date	Update	New Registration		4/1/2023 12:00:00 AM	1/23/2023 2:40 PM
Addresses	Main Address	Insert	New Registration		36555 26 MILE RD STE 1400 LENOX, MI 48048-3186	1/9/2023 10:39 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1932396017	1/9/2023 10:39 AM
Medicaid Billing	NPI: State	Insert	New Registration		MI	1/9/2023 10:39 AM
Contacts	Primary Contact	Insert	New Registration		Schaible, Thomas Manager 340B Pharmacy Beaumont Hospital, Grosse Pointe 9475221169	1/9/2023 10:39 AM
Contacts	Authorizing Official	Insert	New Registration		Susick, Nancy Ann COO Beaumont Health 9475223349	1/9/2023 10:39 AM
Details	Assistance Received From Date	Insert	New Registration			1/9/2023 10:39 AM
Details	Assistance Received To Date	Insert	New Registration			1/9/2023 10:39 AM
Details	Last Recertification Date	Insert	New Registration			1/9/2023 10:39 AM
Details	Grant Number	Insert	New Registration			1/9/2023 10:39 AM
Details	340B ID	Insert	New Registration			1/9/2023 10:39 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/9/2023 10:39 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/9/2023 10:39 AM
Details	Medicare Provider Number	Insert	New Registration		230089	1/9/2023 10:39 AM
Details	Entity Name	Insert	New Registration		BEAUMONT HEALTH - GROSSE POINTE	1/9/2023 10:39 AM
Details	NOFO Number	Insert	New Registration			1/9/2023 10:39 AM
Details	Program Code	Insert	New Registration		DSH	1/9/2023 10:39 AM
Details	Entity Subname	Insert	New Registration		DIAGNOSTIC IMAGING-LENOX	1/9/2023 10:39 AM
Dates	Participating Approval Date	Insert	New Registration			1/9/2023 10:39 AM
Details	State	Insert	New Registration		Pending	1/9/2023 10:39 AM
Dates	Registration Date	Insert	New Registration		1/9/2023 10:39:32 AM	1/9/2023 10:39 AM
Dates	Signed By Date	Insert	New Registration			1/9/2023 10:39 AM
Dates	Start Date	Insert	New Registration			1/9/2023 10:39 AM
Terminations	Termination Comments	Insert	New Registration			1/9/2023 10:39 AM
Terminations	Termination Date	Insert	New Registration			1/9/2023 10:39 AM
Terminations	Termination Effective Date	Insert	New Registration			1/9/2023 10:39 AM
Terminations	Termination Reason	Insert	New Registration			1/9/2023 10:39 AM