340B Drug Pricing Program Database
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DSH230165H 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 MACOMB TOWNSHIP CAMPUS / SJHMC 23 Mile Surgery Center
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH230165H
Medicare Provider Number
230165
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/5/2016
Participating Start Date
10/1/2016
Participating Approval Date
8/19/2016
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
17700 23 MILE ROAD
MACOMB, MI 48044
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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8/19/16 Participated starting 4/1/2006, terminated 7/1/2016, reinstated 10/1/2016.
08/19/2016
7/18/2007-NEW NAME & ADDRESS. WAS: ROMEO PLANK OUTPATIENT SATELLITE 46591 ROMEO PLANK RD MACOMB TOWNSHIP, MI 48044
07/18/2007
7/18/2007-NEW NAME & ADDRESS. WAS: ROMEO PLANK OUTPATIENT SATELLITE 46591 ROMEO PLANK RD MACOMB TOWNSHIP, MI 48044
07/18/2007
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