Main works will now start this month with the hospital due to open to the public in 2022.
At construction peak the project will employ a workforce of 760.
The contract signing has been held-up by a funding wrangle which has now been settled by the Sandwell and West Birmingham Hospitals NHS Trust.
Balfour was appointed to deliver an Early Works contract in 2018 following the collapse of original contractor Carillion.
The firm will now progress with the main construction works to the 80,000 square metre hospital including the completion of the external façade, and all associated mechanical, electrical and plumbing services, delivered by Balfour Beatty Kilpatrick.
Dean Banks, Chief Executive Officer of Balfour Beatty’s UK Construction Services business, said: “This is a key project for the Midlands and a long-awaited moment for healthcare services in the local community.
“Following the successful completion of the Early Works phase, we are pleased that we have been entrusted to deliver the final elements of the scheme.
“Our wealth of experience and expertise will ensure that the Midland Metropolitan Hospital will service future generations for years to come.”
Richard Samuda, Chairman of Sandwell and West Birmingham NHS Trust, said: “The people of Sandwell and West Birmingham have been waiting for this hospital for too long, as have our staff who are doing an incredible job delivering health care services from some buildings that are no longer best suited for modern healthcare services.
“This news cannot come soon enough for those colleagues. Reaching this milestone is testament to the determination of Trust colleagues and leaders in partner organisations, who, with the support of cross party political leaders, have enabled us to agree this contract to complete the hospital.”
Toby Lewis, Chief Executive of Sandwell and West Birmingham NHS Trust, added: “Today is about moving on and looking to the future, as we shortly welcome the return of all works and trades to the site to complete this vital facility.
“The Commonwealth Games comes to Birmingham in 2022, and we would like to be in our new home by then, bringing our clinical teams together to deliver the best acute services for our patients and their families.”