340B Drug Pricing Program Database
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DSH230092CW W. A. Foote Memorial Hospital dba Henry Ford Health Jackson Hospital (Terminated)
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Main Details
Name
W. A. Foote Memorial Hospital dba Henry Ford Health Jackson Hospital
Subdivision Name
Henry Ford Allegiance Vascular Lab - Mason - Henry Ford Allegiance Vascular Lab - Mason
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH230092CW
Medicare Provider Number
230092
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/12/2022
Participating Start Date
10/1/2022
Participating Approval Date
7/26/2022
Last Recertification Date
8/18/2023
Termination Date
Termination Reason
10/1/2024
Business decision by the Covered Entity
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
810 N Hogsback Rd
B
Mason, MI 48854
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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