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AFFILIATED HEALTH SERVICES, INC.
CAH231315-00 ASCENSION BORGESS-LEE HOSPITAL
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Covered Entity Details
Entity Name
ASCENSION BORGESS-LEE HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH231315-00
Entity Address
420 WEST HIGH STREET
DOWAGIAC, MI 49047
Medicare Provider Number
231315
Participating Start Date
9/30/2010
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
AFFILIATED HEALTH SERVICES, INC.
Pharmacy Address
DBA ASCENSION RX 1303
30055 NORTHWESTERN HWY
STE 225
FARMINGTON HILLS, MI 48334
Pharmacy Comments
Contract Details
Approval Date
8/28/2020
Contract Begin Date
8/28/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/13/2022
Ownership change
Contacts
Covered Entity Signing Official
Natalie C Ryder, Chief Administrative Officer
(269) 783-3080
Contract Pharmacy Representative
St. John Hospital & Medical Center
Jon Rys, 340B Program Coordinator
(586) 489-4237
Signed By Date
8/28/2020
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