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AFFILIATED HEALTH SERVICES, INC.
DSH230165T 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
Newland Medical Associates
Type
Disproportionate Share Hospital
340B ID
DSH230165T
Entity Address
31500 Telegraph
Suite 225
Bingham Farms, MI 48025
Medicare Provider Number
230165
Outpatient Facility Provider Number
Participating Start Date
4/1/2012
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
AFFILIATED HEALTH SERVICES, INC.
Pharmacy Address
DBA ASCENSION RX 1303
30055 NORTHWESTERN HWY
STE 225
FARMINGTON HILLS, MI 48334
Pharmacy Comments
Contract Details
Approval Date
2/28/2013
Contract Begin Date
4/1/2013
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
TOMASINE MARX, CHIEF FINANCIAL OFFICER
(313) 343-7676
Contract Pharmacy Representative
Frank Ackley, Pharmacy Director
(586) 228-4591
Signed By Date
1/15/2013
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