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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 1300
11800 E 12 MILE RD
WARREN, MI 48093
Pharmacy Comments
Contract Details
Approval Date
7/15/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Douglas Winner, CFO, Acute Care Operations
(586) 753-0662
Contract Pharmacy Representative
Ascension Health
Rony Foumia, Director, Pharmacy
(248) 303-4425
Signed By Date
7/15/2021
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