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DSH230053JS HENRY FORD HOSPITAL (Terminated)
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Main Details
Name
HENRY FORD HOSPITAL
Subdivision Name
Henry Ford Medical Center Troy Ophthalmology
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH230053JS
Medicare Provider Number
230053
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
5/8/2012
Participating Start Date
7/1/2012
Participating Approval Date
6/5/2012
Last Recertification Date
11/20/2017
Termination Date
Termination Reason
10/1/2018
Site closure
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
2825 Livernois
Troy, MI 48083
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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