340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
HENRY FORD PHARMACY ADVANTAGE
DSH230092 W. A. Foote Memorial Hospital dba Henry Ford Health Jackson Hospital
Print
Covered Entity Details
Entity Name
W. A. Foote Memorial Hospital dba Henry Ford Health Jackson Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230092
Entity Address
205 N. East Ave
JACKSON, MI 49201
Medicare Provider Number
230092
Participating Start Date
4/1/2011
Last Recertification Date
8/23/2024
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
1/20/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
JEANNE WICKENS, SVP OF FINANCE/CFO
(517) 841-6979
Contract Pharmacy Representative
Henry Ford Hospital
Alexander Mansour, 340B Compliance Officer
(248) 723-0020
Signed By Date
1/20/2016
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session