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DSH230165Q Ascension St. John Hospital DBA Henry Ford St. John Hospital (Active)
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Main Details
Name
Ascension St. John Hospital DBA Henry Ford St. John Hospital
Subdivision Name
ST. JOHN HOSPITAL & MEDICAL CENTER- WEBBER CANCER CENTER AND INFUSION CENTER
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH230165Q
Medicare Provider Number
230165
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
12/14/2009
Participating Start Date
12/29/2011
Participating Approval Date
12/15/2009
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
11800 E 12 MILE ROAD
WARREN, MI 48093
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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12/14/2011 Thomasine Marx (VP of Finance and CFO)submitted/e-signed electronic registration dated 11/29/11, entity participating 1/1/10-3/31/10, not participating 4/1/10-12/28/11, immediate start date due to 2011 special exception policy for hospitals; 3/23/10 ENTITY TERM REQUEST RECEIVED
12/29/2011
12/14/2011 Thomasine Marx (VP of Finance and CFO)requested start participation again ;3/23/10 ENTITY TERM REQUEST RECEIVED
12/29/2011
12/14/2011 entity requested start participation again ;3/23/10 ENTITY TERM REQUEST RECEIVED
12/14/2011
3/23/10 ENTITY TERM REQUEST RECEIVED
03/31/2010
April 2025
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