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DSH230165B ST JOHN HOSPITAL & MEDICAL CENTER (Terminated)
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Main Details
Name
ST JOHN HOSPITAL & MEDICAL CENTER
Subdivision Name
PROFESSIONAL BUILDING II
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH230165B
Medicare Provider Number
230165
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
2/22/2006
Participating Start Date
4/1/2006
Participating Approval Date
2/23/2006
Last Recertification Date
8/31/2015
Termination Date
Termination Reason
7/1/2016
Site closure
Contacts
Authorizing Official
St John Providence
Douglas Winner, CFO, Acute Care Operations
(586) 753-0662
Primary Contact
St John Hospital and Medical Center
Gary Blake, Director Pharmacy
(313) 343-3763
Addresses
Street Address
22201 MOROSS ROAD
DETROIT, MI 48236
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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