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DSH230195B 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
ASCENSION MACOMB OAKLAND HOSPITAL - Internal Medicine
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH230195B
Medicare Provider Number
230195
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/14/2021
Participating Start Date
10/1/2021
Participating Approval Date
7/27/2021
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
11885 E 13 MILE RD STE 300A
MOTOR CITY INTERNISTS
WARREN, MI 48093-3023
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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