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DSH230053WJ HENRY FORD HOSPITAL (Terminated)
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Main Details
Name
HENRY FORD HOSPITAL
Subdivision Name
HENRY FORD HEALTH CENTER MILFORD - FAMILY PRACTICE
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH230053WJ
Medicare Provider Number
230053
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/13/2020
Participating Start Date
10/1/2020
Participating Approval Date
8/27/2020
Last Recertification Date
8/28/2023
Termination Date
Termination Reason
4/1/2024
Site closure
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
1265 NORTH MILFORD ROAD
MILFORD, MI 48381
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 10/1/2018; terminated 10/1/2019; Reinstated 10/1/2020.
08/25/2020
Participated starting 10/1/2019; terminated 10/1/2019; Reinstated 10/1/2020.
08/17/2020
June 2025
June 2025
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