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DSH230092BB W. A. Foote Memorial Hospital dba Henry Ford Allegiance Health (Terminated)
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Main Details
Name
W. A. Foote Memorial Hospital dba Henry Ford Allegiance Health
Subdivision Name
Henry Ford Allegiance Digestive Health - Ann Arbor Road
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH230092BB
Medicare Provider Number
230092
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/6/2014
Participating Start Date
4/1/2014
Participating Approval Date
2/28/2014
Last Recertification Date
8/16/2018
Termination Date
Termination Reason
4/1/2019
Site closure
Contacts
Authorizing Official
Henry Ford Allegiance Health
Jim Bongiorno, CFO
(517) 205-4899
Primary Contact
W. A. Foote Memorial Hospital dba Henry Ford Allegiance Health
Laura Ratcliff, Manager - Pharmacy Regulatory Program
(517) 205-7557
Addresses
Street Address
4400 Ann Arbor Road
Jackson, MI 49202
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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