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DSH230151D Botsford General Hospital d/b/a Beaumont Hospital - Farmington Hills (Terminated)
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Main Details
Name
Botsford General Hospital d/b/a Beaumont Hospital - Farmington Hills
Subdivision Name
BEAUMONT FAMILY MEDICINE-NOVI (Dept# 730047) -Botsford Family Medicine Ctr
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH230151D
Medicare Provider Number
230151
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/14/2015
Participating Start Date
7/1/2015
Participating Approval Date
5/13/2015
Last Recertification Date
9/2/2019
Termination Date
Termination Reason
7/1/2020
Business decision by the Covered Entity
Contacts
Authorizing Official
Beaumont Health
Carolyn Wilson, Chief Operating Officer
(947) 522-3338
Primary Contact
Beaumont Health
Scott Nastwold, Director, Pharmacy Services
(248) 471-8356
Addresses
Street Address
39475 LEWIS DR
STE 140
NOVI, MI 48377-2977
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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