340B Drug Pricing Program Database
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DSH230165BF Ascension St. John Hospital (Terminated)
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Main Details
Name
Ascension St. John Hospital
Subdivision Name
ASSOCIATES IN INTERNAL MEDICINE - Associates In Internal Medicine
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH230165BF
Medicare Provider Number
230165
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/9/2019
Participating Start Date
1/1/2020
Participating Approval Date
10/18/2019
Last Recertification Date
8/15/2024
Termination Date
Termination Reason
1/1/2025
Site closure
Contacts
Authorizing Official
Henry Ford Hospital
Doug Clark, SVP - Corporate Finance
(313) 874-5446
Primary Contact
Ascension Rx
Kelsey Fiser, 340B Program Director
(615) 222-5190
Addresses
Street Address
18263 E 10 MILE RD STE C
ROSEVILLE, MI 48066-5805
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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