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RRC230130-11 WILLIAM BEAUMONT HOSPITAL dba Beaumont Hospital - Royal Oak (Terminated)
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Main Details
Name
WILLIAM BEAUMONT HOSPITAL dba Beaumont Hospital - Royal Oak
Subdivision Name
Beaumont Medical Center-West Bloomfield / Vascular Services
Type
Rural Referral Center
Rural
Yes
340B ID
RRC230130-11
Medicare Provider Number
230130
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/17/2017
Participating Start Date
4/1/2017
Participating Approval Date
3/11/2017
Last Recertification Date
8/29/2022
Termination Date
Termination Reason
7/1/2023
Business decision by the Covered Entity
Contacts
Authorizing Official
Beaumont Health
Nancy Ann Susick, COO
(947) 522-3349
Primary Contact
Beaumont Hospital - Royal Oak
Sandra Taylor, Pharmacy Director
(248) 898-4086
Addresses
Street Address
6900 Orchard Lake Road
Suite 110
West Bloomfield, MI 48073
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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