340B Drug Pricing Program Database
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DSH230092BL 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 Outpatient Trauma
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH230092BL
Medicare Provider Number
230092
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/14/2016
Participating Start Date
4/1/2016
Participating Approval Date
3/4/2016
Last Recertification Date
11/22/2017
Termination Date
Termination Reason
4/1/2018
Business decision by the Covered Entity
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
205 N. East Avenue
Jackson, MI 49201
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
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