340B Drug Pricing Program Database
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DSH230053PC Henry Ford Hospital (Terminated)
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Main Details
Name
Henry Ford Hospital
Subdivision Name
Henry Ford Medical Center Dearborn Ford Road Chemical Dependency
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH230053PC
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
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
5111 Auto Club Drive
Dearborn, MI 48126
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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