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DSH230151L BOTSFORD HOSPITAL (Terminated)
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Main Details
Name
BOTSFORD HOSPITAL
Subdivision Name
BOTSFORD GENERAL HOSPITAL - Botsford Heart Health Center
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH230151L
Medicare Provider Number
230151
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/15/2018
Participating Start Date
4/1/2018
Participating Approval Date
1/30/2018
Last Recertification Date
8/16/2018
Termination Date
Termination Reason
10/1/2018
Site closure
Contacts
Authorizing Official
Beaumont Health
Carolyn Wilson, Chief Operating Officer
(947) 522-3338
Primary Contact
Beaumont Health
Scott Nastwold, Director, Pharmacy Services
(248) 471-8356
Addresses
Street Address
39475 LEWIS DR, STE 200
BOTSFORD HEART HEALTH CENTER
NOVI, MI 48377-2980
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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