340B Drug Pricing Program Database
HENRY FORD- CSI PHARMACY
DSH230053 HENRY FORD HOSPITAL - information as of 5/6/2025 12:32:32 AM
Covered Entity Details
Entity Name
HENRY FORD HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230053
Entity Address
2799 WEST GRAND BLVD
DETROIT, MI 48202
Medicare Provider Number
230053
Participating Start Date
10/1/2002
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
HENRY FORD- CSI PHARMACY
Pharmacy Address
1414 E MAPLE RD
STE 103
TROY, MI 48083-9935
Pharmacy Comments
Contract Details
Approval Date
1/13/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
James Connelly, CFO
(313) 876-8714
Contract Pharmacy Representative
Mina Sedarous, Pharmacy Supervisor
(313) 543-6300 Ext: 0
Signed By Date
1/13/2014
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