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HENRY FORD PHARMACY ADVANTAGE
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 PHARMACY ADVANTAGE
Pharmacy Address
2799 W GRAND BLVD
STE 100B
DETROIT, MI 48202-2608
Pharmacy Comments
Contract Details
Approval Date
4/16/2013
Contract Begin Date
7/1/2013
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
James Connelly, CFO
(313) 876-8714
Contract Pharmacy Representative
Henry Ford Health System
Daniel Kus, V.P. Pharmacy Services
(248) 723-0252
Signed By Date
4/16/2013
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