340B Drug Pricing Program Database
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DSH230092 W. A. Foote Memorial Hospital dba Henry Ford Health Jackson Hospital (Active)
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Main Details
Name
W. A. Foote Memorial Hospital dba Henry Ford Health Jackson Hospital
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH230092
Medicare Provider Number
230092
Additional Details
Current Program Status
Active
Registration Date
3/8/2011
Participating Start Date
4/1/2011
Participating Approval Date
3/9/2011
Last Recertification Date
8/23/2024
Contacts
Authorizing Official
Henry Ford Hospital
Doug Clark, SVP - Corporate Finance
(313) 874-5446
Primary Contact
W. A. Foote Memorial Hospital dba Henry Ford Allegiance Health
Laura Ratcliff, 340B Program Coordinator
(517) 205-7557
Addresses
Street Address
205 N. East Ave
JACKSON, MI 49201
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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02/15/11 DOC RECD TO CONFIRM ELIG DSH ADJ %
03/15/2011
April 2025
April 2025
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