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AFFILIATED HEALTH SERVICES, INC.
CAH231328-00 Ascension Borgess Allegan Hospital
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Covered Entity Details
Entity Name
Ascension Borgess Allegan Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH231328-00
Entity Address
555 LINN STREET
ALLEGAN, MI 49010
Medicare Provider Number
231328
Participating Start Date
9/2/2010
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
9/3/2020
Contract Begin Date
9/3/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/10/2022
Ownership change
Contacts
Covered Entity Signing Official
Dorotha Hoffman, Interim Administrator
(269) 686-4162
Contract Pharmacy Representative
Ascension Michigan Pharmacy
Deborah Sopo, Pharmacy Manager
(248) 865-3770
Signed By Date
9/3/2020
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