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RRC230146-07 HENRY FORD WYANDOTTE HOSPITAL (Terminated)
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Main Details
Name
HENRY FORD WYANDOTTE HOSPITAL
Subdivision Name
Henry Ford Brownstown - Women's Health
Type
Rural Referral Center
Rural
Yes
340B ID
RRC230146-07
Medicare Provider Number
230146
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/9/2018
Participating Start Date
7/1/2018
Participating Approval Date
6/1/2018
Last Recertification Date
9/7/2020
Termination Date
Termination Reason
10/1/2021
Hospital Outpatient facility no longer eligible
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
23050 West Road, Ste 210
Brownstown, MI 48183
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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