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AFFILIATED HEALTH SERVICES, INC.
DSH230165N Ascension St. John Hospital DBA Henry Ford St. John Hospital
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Covered Entity Details
Entity Name
Ascension St. John Hospital DBA Henry Ford St. John Hospital
Subdivision Name
PROFESSIONAL OFFICE BUILDING - 23 MILE
Type
Disproportionate Share Hospital
340B ID
DSH230165N
Entity Address
17900 23 MILE ROAD
Suite 403
MACOMB, MI 48044
Medicare Provider Number
230165
Outpatient Facility Provider Number
Participating Start Date
4/1/2009
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
AFFILIATED HEALTH SERVICES, INC.
Pharmacy Address
ASCENSION RX 1307
17900 23 MILE RD
STE 104
MACOMB, MI 48044
Pharmacy Comments
Contract Details
Approval Date
4/1/2009
Contract Begin Date
4/1/2009
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
2/26/2009
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