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DSH230165BE Ascension St. John Hospital DBA Henry Ford St. John Hospital (Active)
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Main Details
Name
Ascension St. John Hospital DBA Henry Ford St. John Hospital
Subdivision Name
GREAT LAKES CANCER MANAGEMENT SPECI - Great Lakes Cancer Management Specialists Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH230165BE
Medicare Provider Number
230165
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/11/2019
Participating Start Date
4/1/2019
Participating Approval Date
2/13/2019
Last Recertification Date
8/15/2024
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
17900 23 MILE RD
STE 402
MACOMB, MI 48044-1161
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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