340B Drug Pricing Program Database
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DSH230092CA W. A. Foote Memorial Hospital dba Henry Ford Health Jackson Hospital (Terminated)
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Main Details
Name
W. A. Foote Memorial Hospital dba Henry Ford Health Jackson Hospital
Subdivision Name
HFA BEHAVIORAL HEALTH - E. MICHIGAN - Henry Ford Allegiance Behavioral Health - East Michigan
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH230092CA
Medicare Provider Number
230092
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/16/2018
Participating Start Date
10/1/2018
Participating Approval Date
7/25/2018
Last Recertification Date
8/30/2021
Termination Date
Termination Reason
10/1/2022
Business decision by the Covered Entity
Contacts
Authorizing Official
Henry Ford Allegiance Health
Jim Bongiorno, CFO
(517) 205-4899
Primary Contact
W. A. Foote Memorial Hospital dba Henry Ford Allegiance Health
Laura Ratcliff, Manager - Pharmacy Regulatory Program
(517) 205-7557
Addresses
Street Address
3235 E MICHIGAN AVE
STE 150
JACKSON, MI 49202-3971
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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