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DSH230195 ST. JOHN MACOMB-OAKLAND HOSPITAL DBA Henry Ford Health Warren Hospital (Active)
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Main Details
Name
ST. JOHN MACOMB-OAKLAND HOSPITAL DBA Henry Ford Health Warren Hospital
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH230195
Medicare Provider Number
230195
Additional Details
Current Program Status
Active
Registration Date
10/26/2020
Participating Start Date
1/1/2021
Participating Approval Date
11/30/2020
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
11800 TWELVE MILE RD.
WARREN, MI 48093
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 10/1/2020, terminated 10/13/2020. Reinstated 1/1/2021.
11/23/2020
May 2025
May 2025
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