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HENRY FORD HOME INFUSION
RRC230146-00 HENRY FORD HEALTH WYANDOTTE HOSPITAL
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Covered Entity Details
Entity Name
HENRY FORD HEALTH WYANDOTTE HOSPITAL
Subdivision Name
Type
Rural Referral Center
340B ID
RRC230146-00
Entity Address
2333 BIDDLE
WYANDOTTE, MI 48192
Medicare Provider Number
230146
Participating Start Date
7/1/2018
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
HENRY FORD HOME INFUSION
Pharmacy Address
21298 MELROSE AVENUE
SOUTHFIELD, MI 48075
Pharmacy Comments
Contract Details
Approval Date
10/16/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Robin Damschroder, CFO
(313) 876-8421
Contract Pharmacy Representative
Henry Ford Hospital
Alexander Mansour, 340B Compliance Officer
(248) 723-0020
Signed By Date
10/16/2018
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