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HENRY FORD HEALTH SYSTEM
DSH230053 HENRY FORD HOSPITAL
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Covered Entity Details
Entity Name
HENRY FORD HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230053
Entity Address
2799 WEST GRAND BLVD
DETROIT, MI 48202
Medicare Provider Number
230053
Participating Start Date
10/1/2002
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
HENRY FORD HEALTH SYSTEM
Pharmacy Address
DBA - HENRY FORD HEALTH PLYMOUTH
40777 ANN ARBOR RD E
PLYMOUTH, MI 48170
Pharmacy Comments
Contract Details
Approval Date
7/15/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Doug Clark, SVP - Corporate Finance
(313) 874-5446
Contract Pharmacy Representative
Henry Ford Pharmacy Advantage Southfield
Caren El-Khoury, Pharmacist-Manager
(313) 916-1231
Signed By Date
7/15/2022
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