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DSH230165R 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 and Medical Center-Providence Cancer Center
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH230165R
Medicare Provider Number
230165
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
11/29/2011
Participating Start Date
12/14/2011
Participating Approval Date
12/14/2011
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
22301 Foster Winter Drive
Southfield, MI 48075
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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12/14/11 APPROVED DURING 2011 SPECIAL EXCEPTION POLICY FOR HOSPITALS
12/14/2011
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