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DSH230053PP Henry Ford Hospital (Terminated)
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Main Details
Name
Henry Ford Hospital
Subdivision Name
Henry Ford Medical Center Sterling Heights Depression Care
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH230053PP
Medicare Provider Number
230053
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/10/2013
Participating Start Date
10/1/2013
Participating Approval Date
9/13/2013
Last Recertification Date
9/1/2016
Termination Date
Termination Reason
10/1/2017
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
3500 15 Mile Road
Sterling Heights, MI 48310
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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