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RRC230146-00 HENRY FORD HEALTH WYANDOTTE HOSPITAL (Active)
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Main Details
Name
HENRY FORD HEALTH WYANDOTTE HOSPITAL
Subdivision Name
Type
Rural Referral Center
Rural
Yes
340B ID
RRC230146-00
Medicare Provider Number
230146
Additional Details
Current Program Status
Active
Registration Date
4/9/2018
Participating Start Date
7/1/2018
Participating Approval Date
5/31/2018
Last Recertification Date
8/26/2024
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
2333 BIDDLE
WYANDOTTE, MI 48192
Billing Address
Henry Ford
1 Ford Place
Detroit, MI 48202
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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