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DSH230165AY ST JOHN HOSPITAL & MEDICAL CENTER (Terminated)
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Main Details
Name
ST JOHN HOSPITAL & MEDICAL CENTER
Subdivision Name
SJHMC-VINAY MALVYIA Gynecology Oncology
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH230165AY
Medicare Provider Number
230165
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/12/2016
Participating Start Date
7/1/2016
Participating Approval Date
5/25/2016
Last Recertification Date
8/24/2016
Termination Date
Termination Reason
10/1/2017
Site closure
Contacts
Authorizing Official
St John Providence
Douglas Winner, CFO, Acute Care Operations
(586) 753-0662
Primary Contact
St John Hospital and Medical Center
Gary Blake, Director Pharmacy
(313) 343-3763
Addresses
Street Address
22301 FOSTER WINTER DR 3
SOUTHFIELD, MI 48075-3707
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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