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AFFILIATED HEALTH SERVICES, INC.
DSH230195 ST. JOHN MACOMB-OAKLAND HOSPITAL DBA Henry Ford Health Warren Hospital
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Covered Entity Details
Entity Name
ST. JOHN MACOMB-OAKLAND HOSPITAL DBA Henry Ford Health Warren Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230195
Entity Address
11800 TWELVE MILE RD.
WARREN, MI 48093
Medicare Provider Number
230195
Participating Start Date
1/1/2021
Last Recertification Date
8/15/2024
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
1/15/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Douglas Winner, CFO, Acute Care Operations
(586) 753-0662
Contract Pharmacy Representative
Ascension Michigan Pharmacy
Deborah Sopo, Pharmacy Manager
(248) 865-3770
Signed By Date
1/15/2021
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