340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
ST JOHN PHARMACY
DSH230165 Ascension St. John Hospital DBA Henry Ford St. John Hospital
Print
Covered Entity Details
Entity Name
Ascension St. John Hospital DBA Henry Ford St. John Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230165
Entity Address
22101 MOROSS ROAD
DETROIT, MI 48236
Medicare Provider Number
230165
Participating Start Date
4/1/2006
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
ST JOHN PHARMACY
Pharmacy Address
27351 DEQUINDRE
MADISON HEIGHTS, MI 48071
Pharmacy Comments
Contract Details
Approval Date
10/12/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/5/2021
Pharmacy closed
Contacts
Covered Entity Signing Official
TOMASINE MARX, CHIEF FINANCIAL OFFICER
(313) 343-7676
Contract Pharmacy Representative
St John Hospital and Medical Center
Gary Blake, Director Pharmacy
(313) 343-3763
Signed By Date
10/12/2014
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session