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AFFILIATED HEALTH SERVICES, INC.
RRC230019-00 ASCENSION PROVIDENCE HOSPITAL DBA HENRY FORD HEALTH PROVIDENCE SOUTHFIELD HOSPITAL
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Covered Entity Details
Entity Name
ASCENSION PROVIDENCE HOSPITAL DBA HENRY FORD HEALTH PROVIDENCE SOUTHFIELD HOSPITAL
Subdivision Name
Type
Rural Referral Center
340B ID
RRC230019-00
Entity Address
16001 WEST NINE MILE ROAD
SOUTHFIELD, MI 48075
Medicare Provider Number
230019
Participating Start Date
4/1/2023
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
AFFILIATED HEALTH SERVICES, INC.
Pharmacy Address
DBA ASCENSION RX 1301
22250 PROVIDENCE DR
SOUTHFIELD, MI 48075-4825
Pharmacy Comments
Contract Details
Approval Date
2/16/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Douglas Winner, CFO, Acute Care Operations
(586) 753-0662
Contract Pharmacy Representative
Business Operations Manager
Greg Hernandez, Affiliated Health Services Inc.
(586) 298-1733
Signed By Date
1/17/2023
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