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AFFILIATED HEALTH SERVICES, INC.
DSH230165E 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
OUTPATIENT SURGERY CENTER / SJHMC Surgery Center
Type
Disproportionate Share Hospital
340B ID
DSH230165E
Entity Address
21000 TWELVE MILE ROAD
ST CLAIR SHORES, MI 48081
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
DBA ASCENSION RX 1315
21000 E 12 MILE RD
STE 124
SAINT CLAIR SHORES, MI 48081-1184
Pharmacy Comments
Contract Details
Approval Date
4/1/2006
Contract Begin Date
4/1/2006
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
4/20/2006
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