340B Drug Pricing Program Database
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DSH230092BQ W. A. Foote Memorial Hospital dba Henry Ford Health Jackson Hospital (Active)
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Main Details
Name
W. A. Foote Memorial Hospital dba Henry Ford Health Jackson Hospital
Subdivision Name
Henry Ford Family Medicine - Brooklyn
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH230092BQ
Medicare Provider Number
230092
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/14/2017
Participating Start Date
7/1/2017
Participating Approval Date
4/25/2017
Last Recertification Date
8/25/2024
Contacts
Authorizing Official
Henry Ford Hospital
Doug Clark, SVP - Corporate Finance
(313) 874-5446
Primary Contact
W. A. Foote Memorial Hospital dba Henry Ford Allegiance Health
Laura Ratcliff, 340B Program Coordinator
(517) 205-7557
Addresses
Street Address
153 Wamplers Lake Rd
Brooklyn, MI 49230
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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