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RRC230146-34 HENRY FORD HEALTH WYANDOTTE HOSPITAL (Active)
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Main Details
Name
HENRY FORD HEALTH WYANDOTTE HOSPITAL
Subdivision Name
HENRY FORD MEDICAL CENTER BROWNSTOWN - UROGYNECOLOGY
Type
Rural Referral Center
Rural
Yes
340B ID
RRC230146-34
Medicare Provider Number
230146
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/9/2024
Participating Start Date
1/1/2025
Participating Approval Date
10/10/2024
Last Recertification Date
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
23050 WEST RD
SUITE 230
BROWNSTOWN, MI 48183
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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