340B Drug Pricing Program Database
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DSH230092E W. A. Foote Memorial Hospital dba Henry Ford Health Jackson Hospital (Terminated)
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Main Details
Name
W. A. Foote Memorial Hospital dba Henry Ford Health Jackson Hospital
Subdivision Name
Henry Ford General Surgery - Professional Building
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH230092E
Medicare Provider Number
230092
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/21/2021
Participating Start Date
1/1/2022
Participating Approval Date
11/18/2021
Last Recertification Date
8/18/2023
Termination Date
Termination Reason
10/1/2024
Site closure
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
1100 E. MICHIGAN AVENUE
STE 300
JACKSON, MI 49201
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating from effective date: (4/1/2011) until terminated effective date: (7/1/2013), reinstatement effective date: (01/01/2022)
11/18/2021
02/15/11 DOC RECD TO CONFIRM ELIG DSH ADJ %
03/15/2011
May 2025
May 2025
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