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RRC230130-44 WILLIAM BEAUMONT HOSPITAL dba Beaumont Hospital - Royal Oak (Terminated)
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Main Details
Name
WILLIAM BEAUMONT HOSPITAL dba Beaumont Hospital - Royal Oak
Subdivision Name
Beaumont Neuroscience Clinics/Beaumont Plastic & Reconstructive Surgery
Type
Rural Referral Center
Rural
Yes
340B ID
RRC230130-44
Medicare Provider Number
230130
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/4/2019
Participating Start Date
4/1/2019
Participating Approval Date
2/21/2019
Last Recertification Date
8/21/2023
Termination Date
Termination Reason
4/1/2024
Change of covered entity type
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
3555 West 13 Mile Rd
Suite N120
Royal Oak, MI 48073
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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