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DSH230151M Botsford General Hospital d/b/a Beaumont Hospital - Farmington Hills (Terminated)
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Main Details
Name
Botsford General Hospital d/b/a Beaumont Hospital - Farmington Hills
Subdivision Name
BEAUMONT INTERNAL MEDICINE ASSOCIATES-FARMINGTON HILLS (Dept# 730235) -Lemon Internal Medicine
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH230151M
Medicare Provider Number
230151
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/11/2018
Participating Start Date
10/1/2018
Participating Approval Date
7/25/2018
Last Recertification Date
8/21/2023
Termination Date
Termination Reason
10/1/2024
Business decision by the Covered Entity
Contacts
Authorizing Official
Corewell Health
Hardik Dalal, SVP, Finance & System-wide Pharmacy Finance
(312) 771-0810
Primary Contact
Corewell Health
Thomas Schaible, Mgr, Pharmacy CHE
(947) 522-1169
Addresses
Street Address
28100 GRAND RIVER AVE STE 206
BEAUMONT MEDICAL GROUP, INTERNAL MEDICINE ASSOCIAT
FARMINGTON HILLS, MI 48336-5969
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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