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DSH230195F ST. JOHN MACOMB-OAKLAND HOSPITAL DBA Henry Ford Health Warren Hospital (Active)
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Main Details
Name
ST. JOHN MACOMB-OAKLAND HOSPITAL DBA Henry Ford Health Warren Hospital
Subdivision Name
ASCENSION MACOMB OAKLAND HOSPITAL - Interventional Radiology 001
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH230195F
Medicare Provider Number
230195
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/12/2024
Participating Start Date
4/1/2024
Participating Approval Date
1/26/2024
Last Recertification Date
8/15/2024
Contacts
Authorizing Official
Henry Ford Hospital
Doug Clark, SVP - Corporate Finance
(313) 874-5446
Primary Contact
Henry Ford Hospital
Alexander Mansour, 340B Compliance Officer
(248) 723-0020
Addresses
Street Address
27351 DEQUINDRE RD
ST JOHN MACOMB OAKLAND HOSPITAL
MADISON HEIGHTS, MI 48071-3487
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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