340B Drug Pricing Program Database
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DSH230151Q 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 GYNECOLOGIC ONCOLOGY-NOVI (Dept# 730073) -Gynecologic Oncology
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH230151Q
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
4/1/2024
Business decision by the Covered Entity
Contacts
Authorizing Official
Corewell Health
Hardik Dalal, SVP, Finance & System-wide Pharmacy Finance
(312) 771-0810
Primary Contact
Beaumont Hospital, Grosse Pointe
Thomas Schaible, Manager 340B Pharmacy
(947) 522-1169
Addresses
Street Address
39475 LEWIS DR STE 270
NOVI, MI 48377-2977
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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