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OPTION CARE ENTERPRISES, INC.
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
OPTION CARE ENTERPRISES, INC.
Pharmacy Address
DBA OPTION CARE
1255 MICHIGAN ST. NE
GRAND RAPIDS, MI 49503
Pharmacy Comments
Contract Details
Approval Date
1/20/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Edward Chadwick, EVP, Finance and Admin & CFO
(313) 876-8714
Contract Pharmacy Representative
Option Care
Jon Adair, Vice President, Health System Solutions
(847) 830-9996
Signed By Date
1/20/2016
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