340B Drug Pricing Program Database
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DSH230053XP HENRY FORD HOSPITAL (Active)
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Main Details
Name
HENRY FORD HOSPITAL
Subdivision Name
Henry Ford Medical Center Ford Road - Occupational Therapy
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH230053XP
Medicare Provider Number
230053
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/13/2020
Participating Start Date
10/1/2020
Participating Approval Date
8/14/2020
Last Recertification Date
8/26/2024
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
5500 Auto Club Drive, Ste 150
Dearborn, MI 48126
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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