340B Drug Pricing Program Database
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RRC230019-32 ASCENSION PROVIDENCE HOSPITAL (Terminated)
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Main Details
Name
ASCENSION PROVIDENCE HOSPITAL
Subdivision Name
LIVONIA INTERNAL MEDICINE - LIVONIA INTERNAL MEDICINE
Type
Rural Referral Center
Rural
Yes
340B ID
RRC230019-32
Medicare Provider Number
230019
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/14/2023
Participating Start Date
7/1/2023
Participating Approval Date
5/3/2023
Last Recertification Date
8/15/2023
Termination Date
Termination Reason
7/1/2024
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
37595 7 MILE RD
STE 330
LIVONIA, MI 48152-1489
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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