340B Drug Pricing Program Database
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DSH230053FE HENRY FORD HOSPITAL (Active)
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Main Details
Name
HENRY FORD HOSPITAL
Subdivision Name
Henry Ford Medical Center Hamtramck Wound Care
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH230053FE
Medicare Provider Number
230053
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/14/2023
Participating Start Date
10/1/2023
Participating Approval Date
8/21/2023
Last Recertification Date
8/26/2024
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
9100 Brombach
Hamtramck, MI 48212
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 7/1/2012; Terminated 10/1/2021; Reinstated 10/1/2023.
08/16/2023
May 2025
May 2025
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