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RRC230130-10 WILLIAM BEAUMONT HOSPITAL (Terminated)
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Main Details
Name
WILLIAM BEAUMONT HOSPITAL
Subdivision Name
Beaumont Medical Center-West Bloomfield / Urgent Care
Type
Rural Referral Center
Rural
Yes
340B ID
RRC230130-10
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
8/16/2018
Termination Date
Termination Reason
4/1/2019
Hospital Outpatient facility no longer eligible
Contacts
Authorizing Official
Beaumont Health
Carolyn Wilson, Chief Operating Officer
(947) 522-3338
Primary Contact
Beaumont Hospital
David Bach, Pharmacy Director
(248) 898-4305
Addresses
Street Address
6900 Orchard Lake Road
LL 100
West Bloomfield, MI 48073
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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