340B Drug Pricing Program Database
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DSH230195A ST. JOHN MACOMB-OAKLAND HOSPITAL (Terminated)
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Main Details
Name
ST. JOHN MACOMB-OAKLAND HOSPITAL
Subdivision Name
ASCENSION MACOMB OAKLAND HOSPITAL - Primary Care
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH230195A
Medicare Provider Number
230195
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/14/2021
Participating Start Date
10/1/2021
Participating Approval Date
7/27/2021
Last Recertification Date
8/16/2023
Termination Date
Termination Reason
10/1/2024
Business decision by the Covered Entity
Contacts
Authorizing Official
Ascension Michigan
Michael McCullough, CFO
(586) 753-0653
Primary Contact
Ascension Rx
Kelsey Fiser, 340B Program Director
(615) 222-5190
Addresses
Street Address
27483 DEQUINDRE ROAD STE 303
HOWARD L DUBIN DO INTERNAL MEDICINE
MADISON HEIGHTS, MI 48071-5715
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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