340B Drug Pricing Program Database
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DSH230092CQ W. A. Foote Memorial Hospital dba Henry Ford Health Jackson Hospital (Active)
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Main Details
Name
W. A. Foote Memorial Hospital dba Henry Ford Health Jackson Hospital
Subdivision Name
Henry Ford Behavioral Health Access Center - Jackson
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH230092CQ
Medicare Provider Number
230092
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/6/2021
Participating Start Date
1/1/2022
Participating Approval Date
10/13/2021
Last Recertification Date
8/25/2024
Contacts
Authorizing Official
Henry Ford Hospital
Doug Clark, SVP - Corporate Finance
(313) 874-5446
Primary Contact
W. A. Foote Memorial Hospital dba Henry Ford Allegiance Health
Laura Ratcliff, 340B Program Coordinator
(517) 205-7557
Addresses
Street Address
205 N EAST AVE
JACKSON, MI 49201-1753
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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