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DSH230053EH HENRY FORD HOSPITAL (Terminated)
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Main Details
Name
HENRY FORD HOSPITAL
Subdivision Name
Henry Ford Medical Center Pierson Anti-Coagulation
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH230053EH
Medicare Provider Number
230053
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
5/11/2012
Participating Start Date
7/1/2012
Participating Approval Date
5/30/2012
Last Recertification Date
8/27/2015
Termination Date
Termination Reason
10/1/2016
Site closure
Contacts
Authorizing Official
Henry Ford Hospital
Doug Clark, SVP - Corporate Finance
(313) 874-5446
Primary Contact
Edward G. Szandzik, Director - Pharmacy
(313) 916-7716
Addresses
Street Address
131 Kercheval Avenue
Grosse Pointe Farms, MI 48236
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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