340B Drug Pricing Program Database
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DSH230165AN Ascension St. John Hospital DBA Henry Ford St. John Hospital (Active)
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Main Details
Name
Ascension St. John Hospital DBA Henry Ford St. John Hospital
Subdivision Name
St John Hospital and Medical Center Anesthesia / Pain Management
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH230165AN
Medicare Provider Number
230165
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/14/2015
Participating Start Date
4/1/2015
Participating Approval Date
3/11/2015
Last Recertification Date
8/15/2024
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
21000 East Twelve Mile Road Suite 100
St Clair Shores, MI 48081
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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