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HENRY FORD HOME INFUSION
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 HOME INFUSION
Pharmacy Address
21298 MELROSE AVENUE
SOUTHFIELD, MI 48075
Pharmacy Comments
Contract Details
Approval Date
10/15/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Joe Schmitt, Sr. VP & Acting CFO
(313) 876-8714
Contract Pharmacy Representative
Henry Ford Home Infusion
Jacob Wong, Pharmacy Manager
(248) 827-3370 Ext: 217
Signed By Date
10/15/2014
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