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DSH230089D WILLIAM BEAUMONT HOSPITAL D/B/A Corewell Health Beaumont Grosse Pointe Hospital (Terminated)
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Main Details
Name
WILLIAM BEAUMONT HOSPITAL D/B/A Corewell Health Beaumont Grosse Pointe Hospital
Subdivision Name
BEAUMONT FAMILY MEDICINE-GROSSE POINTE
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH230089D
Medicare Provider Number
230089
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/14/2020
Participating Start Date
4/1/2020
Participating Approval Date
2/5/2020
Last Recertification Date
9/3/2024
Termination Date
Termination Reason
1/1/2025
Business decision by the Covered Entity
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
16815 E Jefferson Ave
Ste 120
Grosse Pointe, MI 48230
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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