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NOVIXUS PHARMACY SERVICES
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
NOVIXUS PHARMACY SERVICES
Pharmacy Address
43159 WEST NINE MILE ROAD
NOVI, MI 48376
Pharmacy Comments
Contract Details
Approval Date
1/9/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/17/2017
Ownership change
Contacts
Covered Entity Signing Official
James Connelly, CFO
(313) 876-8714
Contract Pharmacy Representative
Novixus Pharmacy Services
Richard Grossman, Vice President of Pharmacy Services
(248) 380-2105
Signed By Date
1/9/2014
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