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AFFILIATED HEALTH SERVICES, INC.
DSH230165H 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
ST. JOHN HOSPITAL MACOMB TOWNSHIP CAMPUS / SJHMC 23 Mile Surgery Center
Type
Disproportionate Share Hospital
340B ID
DSH230165H
Entity Address
17700 23 MILE ROAD
MACOMB, MI 48044
Medicare Provider Number
230165
Outpatient Facility Provider Number
Participating Start Date
10/1/2016
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
7/1/2016
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
2/26/2009
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