340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
ST JOHN PHARMACY
DSH230165C 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
VAN ELSLANDER CANCER CENTER
Type
Disproportionate Share Hospital
340B ID
DSH230165C
Entity Address
19229 MACK AVENUE
GROSSE POINTE WOODS, MI 48236
Medicare Provider Number
230165
Outpatient Facility Provider Number
Participating Start Date
4/1/2006
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
ST JOHN PHARMACY
Pharmacy Address
46591 ROMEO PLANK ROAD
SUITE #125
MACOMB TOWNSHIP, MI 48044
Pharmacy Comments
05/03/2012 changed city (was MACOMB TOWNSHIP)
Contract Details
Approval Date
12/2/2011
Contract Begin Date
12/2/2011
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
TOMASINE MARX, CHIEF FINANCIAL OFFICER
(313) 343-7676
Contract Pharmacy Representative
Frank Ackley, Pharmacy Director
(586) 228-4591
Signed By Date
12/1/2011
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