Covered Entity Details

DSH150109 FRANCISCAN HEALTH LAFAYETTE (Active) - information as of 4/25/2025 12:00:40 AM

Main Details

Name

FRANCISCAN HEALTH LAFAYETTE

Subdivision Name

Type

Disproportionate Share Hospital

Rural

340B ID

DSH150109

Medicare Provider Number

150109

Additional Details

Current Program Status

Active

Registration Date

4/6/2021

Participating Start Date

4/26/2021

Participating Approval Date

4/19/2021

Last Recertification Date

8/21/2024

Contacts

Authorizing Official

Franciscan Health
Jason Geddes, Regional CFO
(765) 502-4599

Primary Contact

Franciscan Health
Laura Shondell, Administrative Director Medication Systems and Operations
(765) 423-6900

Addresses

Street Address

1701 SOUTH CREASY LANE
LAFAYETTE, IN 47905

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
Participating Start Date 7/1/2006, Termination 10/1/2020, Reinstatement 4/26/2021	04/26/2021
3/14/12 name cahnge information provided 3/17/10 NAME CHANGE & ADDR CHANGE (WAS HOME HOSPITAL 2400 SOUTH STREET)8/25/09 - DOC RECD TO CONFIRM ELIG DSH ADJ %	03/14/2012
3/17/10 NAME CHANGE & ADDR CHANGE (WAS HOME HOSPITAL 2400 SOUTH STREET)8/25/09 - DOC RECD TO CONFIRM ELIG DSH ADJ %	03/17/2010

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
IN	100269040A	1356435341
IL		1356435341

Shipping Addresses

Shipping Address 1

Franciscan Health Lafayette
1701 S Creasy Ln
Lafayette, IN 47905

Shipping Address 2

Franciscan Alliance, Inc. DBA Franciscan Outpatient Pharmacy Lafayette
1701 S Creasy Lane
Room 1K71
Lafayette, IN 47905

Shipping Address 3

Franciscan Alliance, Inc. DBA Franciscan Home Infusion Pharmacy Lafayette
1501 Hartford St RM G540
Lafayette, IN 47904

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	04/12/2023	07/01/2023		07/01/2023
Contract Detail	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	04/12/2023	07/01/2023		07/01/2023
Contract Detail	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	04/12/2023	07/01/2023		07/01/2023
Contract Detail	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	04/12/2023	07/01/2023		07/01/2023
Contract Detail	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	04/12/2023	07/01/2023		07/01/2023
Contract Detail	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	04/12/2023	07/01/2023		07/01/2023
Contract Detail	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	04/12/2023	07/01/2023		07/01/2023
Contract Detail	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	04/12/2023	07/01/2023		07/01/2023
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	04/12/2023	07/01/2023		07/01/2023
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	04/12/2023	07/01/2023		07/01/2023
Contract Detail	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	04/12/2023	07/01/2023		07/01/2023
Contract Detail	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	04/12/2023	07/01/2023		07/01/2023
Contract Detail	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	04/12/2023	07/01/2023		07/01/2023
Contract Detail	FRANCISCAN ALLIANCE INC	DBA FRANCISCAN OUTPATIENT PHARMACY - LAF	1701 S CREASY LN ROOM 1K71	LAFAYETTE	IN	47905	01/08/2016	04/01/2016	10/01/2020	10/01/2020
Contract Detail	FRANCISCAN ALLIANCE INC	DBA FRANCISCAN OUTPATIENT PHARMACY - LAF	1701 S CREASY LN ROOM 1K71	LAFAYETTE	IN	47905	04/19/2021	07/01/2021	12/16/2024	02/18/2025
Contract Detail	FRANCISCAN ALLIANCE, INC.	DBA FRANCISCAN HOME INFUSION PHARMACY LA	1501 HARTFORD ST RM G540	LAFAYETTE	IN	47904	01/16/2023	04/01/2023	12/16/2024	02/18/2025
Contract Detail	FRANCISCAN ALLIANCE, INC.	DBA FRANCISCAN HOME INFUSION PHARMACY MU	757 45TH AVE SUITE 102	MUNSTER	IN	46321	10/15/2024	01/01/2025	04/30/2025	04/10/2025
Contract Detail	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 06937	820 N. VERMILION	DANVILLE	IL	61832	04/19/2023	07/01/2023		07/01/2023
Contract Detail	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 08657	1725 SALEM STREET	LAFAYETTE	IN	47904	04/12/2023	07/01/2023		07/01/2023
Contract Detail	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06537	850 N. PLYMOUTH RD.	WINAMAC	IN	46996	04/12/2023	07/01/2023		07/01/2023
Contract Detail	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06914	5765 EAST STATE ROAD 10	DEMOTTE	IN	46310	04/12/2023	07/01/2023		07/01/2023
Contract Detail	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06534	717 NORTH 3RD STREET	LOGANSPORT	IN	46947	04/12/2023	07/01/2023		07/01/2023
Contract Detail	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06669	511 THIRD ST.	COVINGTON	IN	47932	04/12/2023	07/01/2023		07/01/2023
Contract Detail	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06539	103 S. OHIO ST.	CULVER	IN	46511	04/12/2023	07/01/2023		07/01/2023
Contract Detail	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 08680	2806 OLD US HIGHWAY 231 S	LAFAYETTE	IN	47909	04/12/2023	07/01/2023		07/01/2023
Contract Detail	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06688	820 WEST OHIO STREET	ROCKVILLE	IN	47872	04/12/2023	07/01/2023		07/01/2023
Contract Detail	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06531	3404 EAST MARKET ST	LOGANSPORT	IN	46947	04/12/2023	07/01/2023	01/14/2025	02/18/2025
Contract Detail	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06670	512 E. SEYMOUR ST.	KENTLAND	IN	47951	04/12/2023	07/01/2023		07/01/2023
Contract Detail	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06906	107 N. CULLEN ST.	RENSSELAER	IN	47978	04/12/2023	07/01/2023		07/01/2023
Contract Detail	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06667	201 SOUTH JACKSON STREET	FRANKFORT	IN	46041	04/12/2023	07/01/2023		07/01/2023
Contract Detail	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06668	106 EAST MARKET STREET	CRAWFORDSVILLE	IN	47933	04/12/2023	07/01/2023		07/01/2023
Contract Detail	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06674	505 WEST MAIN STREET	DELPHI	IN	46923	04/12/2023	07/01/2023		07/01/2023
Contract Detail	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06677	3630 S. 18TH ST.	LAFAYETTE	IN	47909	04/12/2023	07/01/2023		07/01/2023
Contract Detail	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06673	200 WEST JACKSON STREET	ATTICA	IN	47918	04/12/2023	07/01/2023		07/01/2023
Contract Detail	HOOK-SUPERX, L.L.C.	CVS/PHARMACY # 10257	720 NORTHWESTERN AVE, STE #6	WEST LAFAYETTE	IN	47906	04/12/2023	07/01/2023		07/01/2023
Contract Detail	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06675	366 W MAIN STREET	ROSSVILLE	IN	46065	04/12/2023	07/01/2023	06/11/2024	06/24/2024
Contract Detail	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06535	831 NORTH MAIN STREET	MONTICELLO	IN	47960	04/12/2023	07/01/2023		07/01/2023
Contract Detail	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 08651	512 SAGAMORE PKWY WEST	WEST LAFAYETTE	IN	47906	04/19/2023	07/01/2023		07/01/2023
Contract Detail	ONCOMED THE ONCOLOGY PHARMACY OF BUFFALO	D/B/A ONCO360	140 JOHN JAMES AUDUBON PKWY STE 101	AMHERST	NY	14228	10/14/2018	01/01/2019	10/01/2020	10/01/2020
Contract Detail	ONCOMED THE ONCOLOGY PHARMACY OF BUFFALO	D/B/A ONCO360	140 JOHN JAMES AUDUBON PKWY STE 101	AMHERST	NY	14228	07/15/2022	10/01/2022		10/01/2022
Contract Detail	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	04/12/2023	07/01/2023		07/01/2023
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	04/12/2023	07/01/2023		07/01/2023
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY OR CARELONRX SPECIALTY	ONE WATERFRONT PLAZA 500 ALA MOANA BLVD., BLDG 1	HONOLULU	HI	96813	04/12/2023	07/01/2023		07/01/2023
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	04/12/2023	07/01/2023		07/01/2023
Contract Detail	SINA DRUG LLC	D/B/A ONCO 360	13410 EASTPOINT CENTRE DR STE 101	LOUISVILLE	KY	40223	10/14/2018	01/01/2019	10/01/2020	10/01/2020
Contract Detail	SINA DRUG LLC	D/B/A ONCO 360	13410 EASTPOINT CENTRE DR STE 101	LOUISVILLE	KY	40223	07/15/2022	10/01/2022		10/01/2022
Contract Detail	SORKIN'S RX LTD	D/B/A CAREMED PHARMACEUTICAL SERVICES	1985 MARCUS AVE STE 130	NEW HYDE PARK	NY	11042-2024	10/14/2018	01/01/2019	10/01/2020	10/01/2020
Contract Detail	SORKIN'S RX LTD	D/B/A CAREMED PHARMACEUTICAL SERVICES	1985 MARCUS AVE STE 130	NEW HYDE PARK	NY	11042-2024	07/15/2022	10/01/2022		10/01/2022
Contract Detail	WALGREEN CO	DBA: WALGREENS #10858	130 S CREASY LANE	LAFAYETTE	IN	47905	08/31/2012	08/31/2012	10/01/2020	10/01/2020
Contract Detail	WALGREEN CO	DBA: WALGREENS #10974	2800 OLD US HWY 231 S	LAFAYETTE	IN	47909	08/31/2012	08/31/2012	10/01/2020	10/01/2020
Contract Detail	WALGREEN CO	DBA: WALGREENS #10858	130 S CREASY LANE	LAFAYETTE	IN	47905	01/16/2023	04/01/2023		04/01/2023
Contract Detail	WALGREEN CO	DBA: WALGREENS #10532	812 W BROADWAY STREET	MONTICELLO	IN	47960-2011	01/16/2023	04/01/2023	04/03/2024	06/24/2024
Contract Detail	WALGREEN CO	DBA: WALGREENS #10974	2800 OLD US HWY 231 S	LAFAYETTE	IN	47909	01/16/2023	04/01/2023		04/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04371	1801 SOUTH ST.	LAFAYETTE	IN	47904	08/31/2012	08/31/2012	10/01/2020	10/01/2020
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06456	1000 SAGAMORE PKWY W	WEST LAFAYETTE	IN	47906	08/31/2012	08/31/2012	10/01/2020	10/01/2020
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06456	1000 SAGAMORE PKWY W	WEST LAFAYETTE	IN	47906	01/16/2023	04/01/2023		04/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04371	1801 SOUTH ST.	LAFAYETTE	IN	47904	01/16/2023	04/01/2023		04/01/2023
Contract Detail	WALGREEN CO.	WALGREENS SPECIALTY PHARMACY #15323	9002 N MERIDIAN ST STE 213	INDIANAPOLIS	IN	46260	01/16/2023	04/01/2023		04/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07736	110 W MARKET ST	CRAWFORDSVILLE	IN	47933-1722	01/16/2023	04/01/2023		04/01/2023
Contract Detail	Walgreens Central Fill #21399	4132Plainfield Rd	Ste 110	Indianapolis	IN	46231-7021	04/12/2023	07/01/2023		07/01/2023
Contract Detail	WALGREENS MAIL SERVICE, INC.		8337 S PARK CIRCLE	ORLANDO	FL	32819-9049	03/01/2013	04/01/2013	07/09/2015	10/25/2016

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH150109A	Child	DSH	FRANCISCAN HEALTH LAFAYETTE	Indiana Packers Employee Health Clinic	1165 N US Highway 421	Delphi	IN	Terminated
DSH150109B	Child	DSH	FRANCISCAN HEALTH LAFAYETTE	Adults & Pediatrics	1501 Hartford St.	Lafayette	IN	Terminated
DSH150109C	Child	DSH	FRANCISCAN HEALTH LAFAYETTE	HYPERBARIC OXYGEN THERAPY	1501 Hartford St.	Lafayette	IN	Terminated
DSH150109D	Child	DSH	FRANCISCAN HEALTH LAFAYETTE	Wound Care	1501 Hartford St.	Lafayette	IN	Terminated
DSH150109E	Child	DSH	FRANCISCAN HEALTH LAFAYETTE	MARIE CANINE CANCER CENTER - LE CR Medical Oncology	1706 LAFAYETTE RD	CRAWFORDSVILLE	IN	Active
DSH150109F	Child	DSH	FRANCISCAN HEALTH LAFAYETTE	Franciscan Health Pharmacotherapy, a department of Franciscan Health Lafayette	1116 N 16th St	Lafayette	IN	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Addresses	Shipping Address	Insert	Change Request		Franciscan Health Lafayette 1701 S Creasy Ln Lafayette, IN 47905	12/3/2024 8:07 AM
Addresses	Shipping Address	Insert	Change Request		Franciscan Alliance, Inc. DBA Franciscan Outpatient Pharmacy Lafayette 1701 S Creasy Lane Room 1K71 Lafayette, IN 47905	12/3/2024 8:07 AM
Addresses	Shipping Address	Insert	Change Request		Franciscan Alliance, Inc. DBA Franciscan Home Infusion Pharmacy Lafayette 1501 Hartford St RM G540 Lafayette, IN 47904	12/3/2024 8:07 AM
Details	Last Recertification Date	Update	Recertification	8/29/2023 2:52:43 PM	8/21/2024 1:45:26 PM	8/21/2024 1:45 PM
Details	Last Recertification Date	Update	Recertification	9/13/2022 11:46:13 AM	8/29/2023 2:52:43 PM	8/29/2023 2:52 PM
Details	Last Recertification Date	Update	Recertification	9/10/2021 11:56:16 AM	9/13/2022 11:46:13 AM	9/13/2022 11:46 AM
Contacts	Primary Contact	Update	Contract Pharmacy Change Request	Shondell, Laura Administrative Director Medication Systems and Operations Franciscan Alliance, Inc. 7654236900	Shondell, Laura Administrative Director Medication Systems and Operations Franciscan Health 7654236900	4/11/2022 4:33 PM
Contacts	Primary Contact	Update	Profile Change Request	Shondell, Laura Administrative Director Medication Systems and Operations Franciscan Health 7654236900	Shondell, Laura Administrative Director Medication Systems and Operations Franciscan Alliance, Inc. 7654236900	4/11/2022 6:44 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1356435341	9/10/2021 11:56 AM
Medicaid Billing	NPI: State	Insert	Recertification		IL	9/10/2021 11:56 AM
Details	Last Recertification Date	Update	Recertification		9/10/2021 11:56:16 AM	9/10/2021 11:56 AM
Details	State	Update	OPA Edit	Approved	Active	4/26/2021 9:04 AM
Dates	Start Date	Update	OPA Edit	7/1/2021 12:00:00 AM	4/26/2021 12:00:00 AM	4/26/2021 9:04 AM
Details	Comments Public	Insert	OPA Edit		Participating Start Date 7/1/2006, Termination 10/1/2020, Reinstatement 4/26/2021	4/26/2021 9:04 AM
Medicaid Billing	NPI: State	Update	Reinstatement		IN	4/19/2021 1:01 PM
Contacts	Signed By	Insert	Reinstatement		Geddes, Jason Regional CFO Franciscan Health 7655024599	4/19/2021 1:01 PM
Details	Last Recertification Date	Update	Reinstatement	9/5/2019 9:11:09 AM		4/19/2021 1:01 PM
Dates	Last Date That 340B Drugs Purchased	Update	Reinstatement	8/31/2020 12:00:00 AM		4/19/2021 1:01 PM
Dates	Participating Approval Date	Update	Reinstatement	6/1/2006 12:00:00 AM	4/19/2021 1:01:09 PM	4/19/2021 1:01 PM
Details	State	Update	Reinstatement	Terminated	Approved	4/19/2021 1:01 PM
Dates	Registration Date	Update	Reinstatement	5/31/2006 12:00:00 AM	4/6/2021 8:15:41 AM	4/19/2021 1:01 PM
Dates	Signed By Date	Update	Reinstatement	5/30/2006 12:00:00 AM	4/8/2021 1:16:33 PM	4/19/2021 1:01 PM
Dates	Start Date	Update	Reinstatement	7/1/2006 12:00:00 AM	7/1/2021 12:00:00 AM	4/19/2021 1:01 PM
Terminations	Termination Date	Update	Reinstatement	10/1/2020 12:00:00 AM		4/19/2021 1:01 PM
Terminations	Termination Effective Date	Update	Reinstatement	8/31/2020 12:00:00 AM		4/19/2021 1:01 PM
Terminations	Termination Reason	Update	Reinstatement	DSH percentage below statutory minimum		4/19/2021 1:01 PM
Details	State	Update		To Be Terminated	Terminated	10/1/2020 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Recertification		8/31/2020 12:00:00 AM	9/4/2020 6:47 AM
Details	State	Update	Recertification	Active	To Be Terminated	9/4/2020 6:47 AM
Terminations	Termination Date	Update	Recertification		10/1/2020 12:00:00 AM	9/4/2020 6:47 AM
Terminations	Termination Effective Date	Update	Recertification		8/31/2020 12:00:00 AM	9/4/2020 6:47 AM
Terminations	Termination Reason	Update	Recertification		DSH percentage below statutory minimum	9/4/2020 6:47 AM
Contacts	Primary Contact	Update	Profile Change Request	Shondell, Laura Administrative Director of Pharmacy Services Franciscan Health 7655024514	Shondell, Laura Administrative Director Medication Systems and Operations Franciscan Health 7654236900	8/30/2020 1:53 PM
Details	Last Recertification Date	Update	Recertification	8/30/2018 2:24:20 PM	9/5/2019 9:11:09 AM	9/5/2019 9:11 AM
Contacts	Primary Contact	Update	Change Request	Harber, Eugene Corporate Pharmacy Manager, 340b Operations Franciscan Alliance 2199322300-35561	Shondell, Laura Administrative Director of Pharmacy Services Franciscan Health 7655024514	7/10/2019 3:23 PM
Details	Last Recertification Date	Update	Recertification	11/8/2017 12:31:07 PM	8/30/2018 2:24:20 PM	8/30/2018 2:24 PM
Contacts	Primary Contact	Update	Change Request	Shondell, Laura Administrative Director of Pharmacy Services Franciscan Health 7655024514	Harber, Eugene Corporate Pharmacy Manager, 340b Operations Franciscan Alliance 2199322300-35561	5/22/2018 3:03 PM
Details	Last Recertification Date	Update	Recertification	9/2/2016 12:00:00 AM	11/8/2017 12:31:07 PM	11/8/2017 12:31 PM
Contacts	Authorizing Official	Update		Geddes, Jason Regional CFO 7655024599	Geddes, Jason Regional CFO Franciscan Health 7655024599	10/24/2017 8:34 AM
Contacts	Primary Contact	Update	Profile Change Request	Shondell, Laura Division Director of Pharmacy Franciscan Health 7655024514	Shondell, Laura Administrative Director of Pharmacy Services Franciscan Health 7655024514	10/3/2017 8:13 AM
Contacts	Primary Contact	Update		Shondell, Laura Division Director of Pharmacy 7655024514	Shondell, Laura Division Director of Pharmacy Franciscan Health 7655024514	10/3/2017 8:12 AM
Contacts	Authorizing Official	Update		DEAKYNE, JEFFERY T. DIVISION DIRECTOR OF ACCOUNTING 7654493152	Geddes, Jason Regional CFO 7655024599	8/13/2017 11:49 AM
Contacts	Primary Contact	Update		DEAKYNE, JEFFERY T. DIVISION DIRECTOR OF ACCOUNTING 7654493152	Shondell, Laura Division Director of Pharmacy 7655024514	8/13/2017 11:49 AM
Addresses	Main Address	Insert			1701 SOUTH CREASY LANE LAFAYETTE, IN 47905	8/13/2017 11:48 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	8/13/2017 11:47 AM
Medicaid Billing	Medicaid: Number	Insert			100269040A	8/13/2017 11:47 AM
Medicaid Billing	Medicaid: State	Insert			IN	8/13/2017 11:47 AM
Medicaid Billing	NPI: Number	Insert			1356435341	8/13/2017 11:47 AM
Details	Entity Name	Update		Franciscan St. Elizabeth Health-Lafayette East	FRANCISCAN HEALTH LAFAYETTE	9/20/2016 11:45 AM
Details	Last Recertification Date	Update		8/18/2015 12:00:00 AM	9/2/2016 12:00:00 AM	9/2/2016 12:24 PM
Details	Last Recertification Date	Update		8/20/2014 12:00:00 AM	8/18/2015 12:00:00 AM	8/18/2015 9:20 AM
Details	Last Recertification Date	Update		8/28/2013 12:00:00 AM	8/20/2014 12:00:00 AM	8/20/2014 1:45 PM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	8/28/2013 12:00:00 AM	8/28/2013 1:05 PM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	5/15/2012 7:38 AM
Details	Entity Name	Update		ST. ELIZABETH EAST	Franciscan St. Elizabeth Health-Lafayette East	3/14/2012 2:10 PM
Details	Comments Public	Insert			3/14/12 name cahnge information provided 3/17/10 NAME CHANGE & ADDR CHANGE (WAS HOME HOSPITAL 2400 SOUTH STREET)8/25/09 - DOC RECD TO CONFIRM ELIG DSH ADJ %	3/14/2012 2:10 PM
Contacts	Authorizing Official	Insert			DEAKYNE, JEFFERY T. DIVISION DIRECTOR OF ACCOUNTING 7654493152	3/17/2010 1:59 PM
Contacts	Primary Contact	Insert			DEAKYNE, JEFFERY T. DIVISION DIRECTOR OF ACCOUNTING 7654493152	3/17/2010 1:59 PM
Details	Last Recertification Date	Insert				3/17/2010 1:59 PM
Details	Grant Number	Insert				3/17/2010 1:59 PM
Details	340B ID	Insert			DSH150109	3/17/2010 1:59 PM
Details	Is Authorizing Official EHB Data	Insert				3/17/2010 1:59 PM
Dates	Last Date That 340B Drugs Purchased	Insert				3/17/2010 1:59 PM
Details	Medicare Provider Number	Insert			150109	3/17/2010 1:59 PM
Details	Entity Name	Insert			ST. ELIZABETH EAST	3/17/2010 1:59 PM
Details	Program Code	Insert			DSH	3/17/2010 1:59 PM
Details	Entity Subname	Insert				3/17/2010 1:59 PM
Dates	Participating Approval Date	Insert			6/1/2006 12:00:00 AM	3/17/2010 1:59 PM
Details	State	Insert			Active	3/17/2010 1:59 PM
Dates	Registration Date	Insert			5/31/2006 12:00:00 AM	3/17/2010 1:59 PM
Dates	Signed By Date	Insert			5/30/2006 12:00:00 AM	3/17/2010 1:59 PM
Dates	Start Date	Insert			7/1/2006 12:00:00 AM	3/17/2010 1:59 PM
Terminations	Termination Comments	Insert				3/17/2010 1:59 PM
Terminations	Termination Date	Insert				3/17/2010 1:59 PM
Terminations	Termination Effective Date	Insert				3/17/2010 1:59 PM
Terminations	Termination Reason	Insert				3/17/2010 1:59 PM
Details	Comments Public	Insert			3/17/10 NAME CHANGE & ADDR CHANGE (WAS HOME HOSPITAL 2400 SOUTH STREET)8/25/09 - DOC RECD TO CONFIRM ELIG DSH ADJ %	3/17/2010 1:59 PM