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RRC230029-00 ST. JOSEPH MERCY HOSPITAL-OAKLAND (Terminated)
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Main Details
Name
ST. JOSEPH MERCY HOSPITAL-OAKLAND
Subdivision Name
Type
Rural Referral Center
Rural
Yes
340B ID
RRC230029-00
Medicare Provider Number
230029
Additional Details
Current Program Status
Terminated
Registration Date
1/7/2021
Participating Start Date
2/2/2021
Participating Approval Date
1/22/2021
Last Recertification Date
8/25/2021
Termination Date
Termination Reason
7/1/2022
Change of covered entity type
Contacts
Authorizing Official
St. Joseph Mercy Oakland Hospital
Michael Gusho, Regional Chief Financial Officer
(248) 858-6174
Primary Contact
Trinity Health Oakland Hospital
Phillip J. Wein, Director of Pharmacy
(248) 858-3053
Addresses
Street Address
44405 WOODWARD AVENUE
PONTIAC, MI 48341
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 4/1/2019, terminated 1/1/2020. Reinstated 2/2/2021.
02/02/2021
The Office of Pharmacy Affairs (OPA) recognizes that any Contract Pharmacy with a termination date of 10/02/2019 is active until 1/1/2020.
10/04/2019
May 2025
May 2025
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