340B Drug Pricing Program Database


DSH150021 Parkview Hospital (Active) - information as of 4/24/2025 10:13:48 PM

Main Details
Parkview Hospital
Disproportionate Share Hospital
Yes
DSH150021
150021


Additional Details
Active
7/15/2015
10/1/2015
8/31/2015
8/14/2024

Contacts

Parkview Health System
Stanton Risser, Assoc Chief Financial Officer
(260) 266-9313

Parkview Health
Stephanie Dickmeyer, 340B Program Supervisor
(260) 266-4408

Addresses

11109 PARKVIEW PLAZA DRIVE
FORT WAYNE, IN 46845

Parkview Memorial Hospital, Inc
2200 Randallia Dr
Fort Wayne, IN 46805


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
Does Parkview Hospital own Medical Park 11 Pharmacy and Parkview Randallia Outpatient Pharmacy? Please reply in the comment section and return. Thank you.02/22/2022
8/31/15 Previously participated 4/1/11 through 7/1/14, terminated due to DSH percentage fell below statutory minimum, reinstated 10/1/15 with a DSH % of 12.17%08/31/2015
04/29/11 REMOVED MEDICAID#(WAS100268480A)04/29/2011
9/28/11 ADDED SUB-DIV NAME; 04/29/11 REMOVED MEDICAID#(WAS100268480A)03/04/2011
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
IN100268480A1366407603,1275305344
OH67232821366407603,1275305344
MI 1366407603,1275305344
Shipping Addresses

Parkview Distribution Center
1450 Production Road
fort wayne, IN 46808

Parkview Hospital Pharmacy
2200 Randallia Drive
Fort Wayne, IN 46805

Parkview Behavioral Health Pharmacy
1720 Beacon St
Fort Wayne, IN 46805

PARKVIEW REGIONAL MEDICAL CENTER PHARMACY
11109 Parkview Plaza Drive
fort wayne, IN 46845

Medical Park 11 Pharmacy
11104 Parkview Circle Dr
Fort Wayne, IN 46845

Parkview Randallia Outpatient Pharmacy
2200 Randallia Drive
Fort Wayne, IN 46805

Parkview Southwest Outpatient Center Pharmacy
8202 Glencarin Boulevard
Fort Wayne, IN 46804

Electric Works Pharmacy
1660 Broadway St., STE 165
Fort Wayne, IN 46802

Parkview Integrated Pharmacy
1450 Production Road STE 400
Fort Wayne, IN 46808

Parkview Home Infusion Services
1450 Production Rd STE 100
Fort Wayne, IN 46808
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailACCREDO HEALTH GROUP INC2040 W RIO SALADO PKWY STE 101B
TEMPEAZ85281-201012/06/201701/01/2018 07/17/201907/17/2019
Contract DetailACCREDO HEALTH GROUP INC3000 ERICSSON DRIVE, SUITE 100
WARRENDALEPA15086-750212/06/201701/01/2018 07/17/201907/17/2019
Contract DetailACCREDO HEALTH GROUP INC1620 CENTURY CENTER PKWY # 109
MEMPHISTN38134-884912/06/201701/01/2018 07/17/201907/17/2019
Contract DetailACCREDO HEALTH GROUP INC1620 CENTURY CENTER PKWY # 109
MEMPHISTN38134-884910/03/201901/01/2020  01/01/2020
Contract DetailACCREDO HEALTH GROUP INC3000 ERICSSON DRIVE, SUITE 100
WARRENDALEPA15086-750210/03/201901/01/2020  01/01/2020
Contract DetailACCREDO HEALTH GROUP INC2040 W RIO SALADO PKWY STE 101B
TEMPEAZ85281-201010/03/201901/01/2020  01/01/2020
Contract DetailACCREDO HEALTH GROUP, INC.2 BOULDEN CIR STE 1
NEW CASTLEDE19720-349212/06/201701/01/2018 07/17/201907/17/2019
Contract DetailACCREDO HEALTH GROUP, INC.2825 W PERIMETER RD STE 112
INDIANAPOLISIN4624112/06/201701/01/2018 07/17/201907/17/2019
Contract DetailACCREDO HEALTH GROUP, INC.6272 LEE VISTA BLVD STE 100
ORLANDOFL3282212/06/201701/01/2018 07/17/201907/17/2019
Contract DetailACCREDO HEALTH GROUP, INC.2 BOULDEN CIR STE 1
NEW CASTLEDE19720-349210/03/201901/01/2020  01/01/2020
Contract DetailACCREDO HEALTH GROUP, INC.2825 W PERIMETER RD STE 112
INDIANAPOLISIN4624110/03/201901/01/2020 06/12/202306/13/2023
Contract DetailACCREDO HEALTH GROUP, INC.6272 LEE VISTA BLVD STE 100
ORLANDOFL3282210/03/201901/01/2020  01/01/2020
Contract DetailACCREDO HEALTH GROUP, INC.4750 E 450 S SUITE A
WHITESTOWNIN4607501/04/202204/01/2022  04/01/2022
Contract DetailADVANCED CARE SCRIPTS, INCCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 6251 CHANCELLOR DRIVE
SUITE 101 		ORLANDOFL3280901/10/202404/01/2024  04/01/2024
Contract DetailAMAZON PHARMACY #0014500 S PLEASANT VALLEY RD STE 201
AUSTINTX78744-291110/17/202201/01/2023 09/11/202409/11/2024
Contract DetailAMAZON PHARMACY #0063620 PLAINFIELD RD
INDIANAPOLISIN46231-700310/17/202201/01/2023 09/11/202409/11/2024
Contract DetailAZ PHARMACY, LLCDBA AMAZON PHARMACY #002 3809 E WATKINS ST
PHOENIXAZ8503410/17/202201/01/2023 09/11/202409/11/2024
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLC376 NORTHLAKE BLVD
ALTAMONTE SPRINGSFL32701-526101/06/202404/01/2024  04/01/2024
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLC13925 YALE AVE STE 145
IRVINECA92620-267001/06/202404/01/2024  04/01/2024
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLC4900 PROSPECTUS DR STE 300
DURHAMNC2771301/06/202404/01/2024  04/01/2024
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLCBIOPLUS SPECIALTY PHARMACY SERVICES, LLC 4740 VICTORY LN STE C
INDIANAPOLISIN4620307/02/202410/01/2024  10/01/2024
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLCBIOPLUS SPECIALTY PHARMACY SERVICES, LLC 145 S 79TH ST STE 70
CHANDLERAZ8522607/02/202410/01/2024  10/01/2024
Contract DetailCAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361407/13/201710/01/2017 08/13/201808/14/2018
Contract DetailCAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361410/03/201901/01/2020  01/01/2020
Contract DetailCAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005607/13/201710/01/2017 08/13/201808/14/2018
Contract DetailCAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005610/03/201901/01/2020  01/01/2020
Contract DetailCAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621907/13/201710/01/2017 08/13/201808/14/2018
Contract DetailCAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621910/03/201901/01/2020  01/01/2020
Contract DetailCAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175707/13/201710/01/2017 08/13/201808/14/2018
Contract DetailCAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175710/03/201901/01/2020  01/01/2020
Contract DetailCAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808307/13/201710/01/2017 08/13/201808/14/2018
Contract DetailCAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808310/03/201901/01/2020  01/01/2020
Contract DetailCAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700407/13/201710/01/2017 08/13/201808/14/2018
Contract DetailCAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700410/03/201901/01/2020  01/01/2020
Contract DetailCAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761707/13/201710/01/2017 08/13/201808/14/2018
Contract DetailCAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761710/03/201901/01/2020  01/01/2020
Contract DetailCAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107 		BARTLETTTN3813307/13/201710/01/2017 08/13/201808/14/2018
Contract DetailCAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107 		BARTLETTTN3813310/03/201901/01/2020  01/01/2020
Contract DetailCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A 		REDLANDSCA9237407/13/201710/01/2017 08/13/201808/14/2018
Contract DetailCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A 		REDLANDSCA9237410/03/201901/01/2020  01/01/2020
Contract DetailCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911907/02/202110/01/2021  10/01/2021
Contract DetailCOMMUNITY HOSPITAL OF LAGRANGEPARKVIEW HEALTH 207 N TOWNLINE RD
LAGRANGEIN46761-139904/11/202407/01/2024  07/01/2024
Contract DetailCOMMUNITY HOSPITAL OF NOBLE401 N SAWYER RD
KENDALLVILLEIN46755-256804/11/202407/01/2024  07/01/2024
Contract DetailCOMMUNITY HOSPITALS & WELLNESS CTRSDBA PARKVIEW BRYAN HOSPITAL 433 W HIGH ST
BRYANOH4350604/03/202507/01/2025  04/03/2025
Contract DetailCORAM ALTERNATE SITE SERVICES, INC.DBA CORAM CVS/SPECIALTY INFUSION SERVICE 431 FERNHILL AVENUE
FORT WAYNEIN4680507/13/201710/01/2017 08/13/201808/14/2018
Contract DetailCORAM ALTERNATE SITE SERVICES, INC.DBA CORAM CVS/SPECIALTY INFUSION SERVICE 431 FERNHILL AVENUE
FORT WAYNEIN4680510/03/201901/01/2020  01/01/2020
Contract DetailCVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502807/02/202110/01/2021  10/01/2021
Contract DetailCYSTIC FIBROSIS SERVICESCYSTIC FIBROSIS SERVICES, INC 10530 JOHN W ELLIOTT DR, STE 200
FRISCOTX7503301/26/201704/01/2017 08/09/201708/09/2017
Contract DetailCYSTIC FIBROSIS SERVICES, LLCDBA WALGREENS SPECIALTY PHARMACY #16280 10530 JOHN W ELLIOTT DR STE 200
FRISCOTX7503306/28/201707/01/2017  06/28/2017
Contract DetailDEKALB HEALTH PHARMACARE - GARRETTD/B/A PARKVIEW PHARMACARE GARRETT 1350 S. RANDOLPH ST.
GARRETTIN4673804/11/202407/01/2024  07/01/2024
Contract DetailDEKALB MEMORIAL PHARMACARE LLCD/B/A PARKVIEW PHARMACARE AUBURN 1314 E 7TH ST STE 104
AUBURNIN46706-253304/11/202407/01/2024  07/01/2024
Contract DetailDOGWOOD PHARMACY LLCD/B/A MEDSCRIPTS MEDICAL PHARMACY 1325 MILLER RD
STE K 		GREENVILLESC29607-654101/06/202404/01/2024  04/01/2024
Contract DetailESI MAIL PHARMACY SERVICEDBA EXPRESS SCRIPTS 7909 S HARDY DR STE 106
TEMPEAZ85284-111210/03/201901/01/2020  01/01/2020
Contract DetailEXPRESS SCRIPTSESI MAIL PHARMACY SERVICE INC 4600 N HANLEY RD
SAINT LOUISMO6313410/03/201901/01/2020  01/01/2020
Contract DetailEXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 2040 ROUTE 130 NORTH
BURLINGTONNJ0801610/03/201901/01/2020  01/01/2020
Contract DetailEXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 4750 E. 450 S.
WHITESTOWNIN4607510/03/201901/01/2020  01/01/2020
Contract DetailHOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06479 1703 CARROLL RD.
FORT WAYNEIN4684510/15/201501/01/2016 02/10/201702/10/2017
Contract DetailHOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06509 2802 EAST STATE BOULEVARD
FORT WAYNEIN4680510/15/201501/01/2016 02/10/201702/10/2017
Contract DetailHUNTINGTON MEMORIAL HOSP2001 STULTS RD
HUNTINGTONIN4675004/11/202407/01/2024  07/01/2024
Contract DetailKROGER COLUMBUS CENTRAL FILL #0192270 RICKENBACKER PKWY W
COLUMBUSOH4321704/19/201607/01/2016 02/10/201702/10/2017
Contract DetailKROGER COLUMBUS CENTRAL FILL #0192270 RICKENBACKER PKWY W
COLUMBUSOH4321707/16/201910/01/2019 11/04/202011/04/2020
Contract DetailKROGER PHARMACY#973 6002 ST JOE CENTER ROAD
FORT WAYNEIN4683504/19/201607/01/2016 02/10/201702/10/2017
Contract DetailKROGER PHARMACY#857 821 LINCOLN HIGHWAY WEST
NEW HAVENIN4677407/16/201910/01/2019 11/04/202011/04/2020
Contract DetailKROGER PHARMACY#874 621 COUNTRYSIDE DRIVE
COLUMBIA CITYIN4672507/16/201910/01/2019 11/04/202011/04/2020
Contract DetailKROGER PHARMACY#973 6002 ST JOE CENTER ROAD
FORT WAYNEIN4683507/16/201910/01/2019 11/04/202011/04/2020
Contract DetailKROGER PHARMACY #4054120 N CLINTON ST
FORT WAYNEIN46805-123004/19/201607/01/2016 02/10/201702/10/2017
Contract DetailKROGER PHARMACY #4054120 N CLINTON ST
FORT WAYNEIN46805-123007/16/201910/01/2019 11/04/202011/04/2020
Contract DetailKROGER PHARMACY #4121125 W STATE BLVD
FORT WAYNEIN46808-318507/16/201910/01/2019 11/04/202011/04/2020
Contract DetailKROGER PHARMACY #418310 W NORTH ST
KENDALLVILLEIN4675504/19/201607/01/2016 02/10/201702/10/2017
Contract DetailKROGER PHARMACY #418310 W NORTH ST
KENDALLVILLEIN4675507/16/201910/01/2019 11/04/202011/04/2020
Contract DetailKROGER PHARMACY #42410230 CHESTNUT PLAZA DR
FORT WAYNEIN46814-897004/19/201607/01/2016 02/10/201702/10/2017
Contract DetailKROGER PHARMACY #4256310 E STATE BLVD
FORT WAYNEIN46815-702304/19/201607/01/2016 02/10/201702/10/2017
Contract DetailKROGER PHARMACY #4256310 E STATE BLVD
FORT WAYNEIN46815-702307/16/201910/01/2019 11/04/202011/04/2020
Contract DetailKROGER PHARMACY #9911001 W. 7TH STREET
AUBURNIN4670607/16/201910/01/2019 11/04/202011/04/2020
Contract DetailKROGER PHARMACY J-4107008 BLUFFTON RD
FORT WAYNEIN46809-270604/19/201607/01/2016 02/10/201702/10/2017
Contract DetailKROGER PHARMACY J-4107008 BLUFFTON RD
FORT WAYNEIN46809-270607/16/201910/01/2019 11/04/202011/04/2020
Contract DetailKROGER PHARMACY J-4272040 PEACE TREE VILLAGE
ROCHESTERIN4697504/19/201607/01/2016 02/10/201702/10/2017
Contract DetailKROGER PHARMACY J-929218 EAST PETTIT
FORT WAYNEIN4680607/16/201910/01/2019 11/04/202011/04/2020
Contract DetailKROGER PHARMACY J-972601 EAST DUPONT ROAD
FORT WAYNEIN4682504/19/201607/01/2016 02/10/201702/10/2017
Contract DetailKROGER PHARMACY J-972601 EAST DUPONT ROAD
FORT WAYNEIN4682507/16/201910/01/2019 11/04/202011/04/2020
Contract DetailKROGER PHARMACY J-9905725 COVENTRY LANE
FT WAYNEIN4680404/19/201607/01/2016 02/10/201702/10/2017
Contract DetailKROGER PHARMACY J-9905725 COVENTRY LANE
FT WAYNEIN4680407/16/201910/01/2019 11/04/202011/04/2020
Contract DetailM.N. PHARMACY LLCDBA AMAZON PHARMACY #003 6701 NW 7TH ST., STE. #199
MIAMIFL3312610/17/202201/01/2023 09/11/202409/11/2024
Contract DetailMEDICAL PARK 11 PHARMACY11104 PARKVIEW CIRCLE DR
FORT WAYNEIN46845-170410/02/201501/01/2016 06/07/202206/07/2022
Contract DetailMEIJER DISTRIBUTION INC #902721 WALKER AVE NW
GRAND RAPIDSMI4954407/16/201910/01/2019 12/13/202212/29/2022
Contract DetailMEIJER INC #1902990 N WAYNE ST
ANGOLAIN4670307/16/201910/01/2019 12/13/202212/29/2022
Contract DetailMEIJER PHARMACY #1246309 LIMA ROAD
FORT WAYNEIN4681807/16/201910/01/2019 12/13/202212/29/2022
Contract DetailMEIJER PHARMACY #1255909 ILLINOIS ROAD
FORT WAYNEIN4680407/16/201910/01/2019 12/13/202212/29/2022
Contract DetailMEIJER PHARMACY #13810301 SR 37 HWY MAYSVILLE RD
FORT WAYNEIN4683507/16/201910/01/2019 12/13/202212/29/2022
Contract DetailMEIJER PHARMACY #46441255 COCA COLA DR.
BELLEVILLEMI48111-182707/16/201910/01/2019 12/13/202212/29/2022
Contract DetailMEIJER STORES LIMITED PARTNERSHIPD/B/A MEIJER PHARMACY #463 1515 PROFIT DR.
FORT WAYNEIN4680807/16/201910/01/2019 12/13/202212/29/2022
Contract DetailOPTUM FRONTIER THERAPIES II, LLC6425 SANTA MARGARITA ST UNIT 110
LAS VEGASNV89118-191310/03/201901/01/2020 11/04/202011/05/2020
Contract DetailOPTUM FRONTIER THERAPIES II, LLC6425 SANTA MARGARITA ST UNIT 110
LAS VEGASNV89118-191304/15/202407/01/2024  07/01/2024
Contract DetailOPTUM INFUSION SERVICES 500 INC1893 GENERAL GEORGE PATTON DR # 100
FRANKLINTN37067-265510/03/201901/01/2020 10/08/201910/21/2019
Contract DetailOPTUM PHARMACY 702, LLC1050 PATROL RD
JEFFERSONVILLEIN4713010/03/201901/01/2020  01/01/2020
Contract DetailOPTUM PHARMACY 705, LLC1893 GENERAL GEORGE PATTON DR STE 106
FRANKLINTN37067-265510/21/201901/01/2020  01/01/2020
Contract DetailOPTUM PHARMACY 705, LLC1100 LEE BRANCH LN
BIRMINGHAMAL35242-729804/15/202407/01/2024  07/01/2024
Contract DetailOPTUM PHARMACY 801, INC.24416 N 19TH AVE STE. 100
PHOENIXAZ8508510/03/201901/01/2020  01/01/2020
Contract DetailOWEN'S PHARMACY J-8412718 GUILFORD ST
HUNTINGTONIN4675007/16/201910/01/2019 11/04/202011/04/2020
Contract DetailPARKVIEW HOME INFUSION SERVS1450 PRODUCTION RD SUITE 100
FORT WAYNEIN4680810/07/202401/01/2025 12/06/202412/06/2024
Contract DetailPARKVIEW KOSCIUSKO HOSPITAL1355 MARINERS DR
WARSAWIN4658204/11/202407/01/2024  07/01/2024
Contract DetailPARKVIEW RANDALLIA OUTPATIENT PHARMACY2200 RANDALLIA DR
FORT WAYNEIN4680510/02/201501/01/2016 06/07/202206/07/2022
Contract DetailPARKVIEW WABASH HOSPITAL, INC.10 JOHN KISSINGER DR
WABASHIN4699204/11/202407/01/2024  07/01/2024
Contract DetailPILLPACK LLCDBA PILLPACK BY AMAZON PHARMACY 250 COMMERCIAL ST STE 2012
MANCHESTERNH0310110/17/202201/01/2023 09/11/202409/11/2024
Contract DetailPRIME THERAPEUTICS SPECIALTY PHARMACY LLALLIANCERX WALGREENS PRIME #16568 2354 COMMERCE PARK DRIVE
SUITE 100 		ORLANDOFL32819-999207/10/201710/01/2017 09/22/202209/27/2022
Contract DetailPROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514607/13/201710/01/2017  10/01/2017
Contract DetailPROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #2909 1521 4TH AVE., SOUTH
BIRMINGHAMAL3523307/02/202110/01/2021  10/01/2021
Contract DetailPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #2923 3250 HARDEN ST. EXT. SUITE #300
COLUMBIASC2920307/02/202110/01/2021  10/01/2021
Contract DetailRAINA RX LLCDBA ROUTE 300 PHARMACY 1208 ROUTE 300
SUITE 103 		NEWBURGHNY1255001/06/202404/01/2024  04/01/2024
Contract DetailRIVER MEDICAL PHARMACY LLC4752 RESEARCH DR
SAN ANTONIOTX78240-500201/06/202404/01/2024  04/01/2024
Contract DetailSANTA BARBARA SPECIALTY PHARMACY LLC4690 CARPINTERIA AVE STE B
CARPINTERIACA9301301/06/202404/01/2024  04/01/2024
Contract DetailWAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738610/14/201501/01/2016 10/31/201810/31/2018
Contract DetailWAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738607/16/201910/01/2019 12/27/202312/27/2023
Contract DetailWAL-MART PHARMACY 10-12943240 SOUTH WESTERN
MARIONIN4695210/14/201501/01/2016 02/10/201702/10/2017
Contract DetailWAL-MART PHARMACY 10-13042501 WALTON BLVD
WARSAWIN4658210/14/201501/01/2016 02/10/201702/10/2017
Contract DetailWAL-MART PHARMACY 10-1333301 TOWN CENTER BLVD
VAN WERTOH4589110/14/201501/01/2016 02/10/201702/10/2017
Contract DetailWAL-MART PHARMACY 10-13882501 E NORTH STREET
KENDALLVILLEIN4675510/14/201501/01/2016 02/10/201702/10/2017
Contract DetailWAL-MART PHARMACY 10-14195311 COLDWATER RD
FORT WAYNE (N)IN4682510/14/201501/01/2016 10/31/201810/31/2018
Contract DetailWAL-MART PHARMACY 10-14195311 COLDWATER RD
FORT WAYNE (N)IN4682507/16/201910/01/2019 12/27/202312/27/2023
Contract DetailWAL-MART PHARMACY 10-1425402 W PLAZA DR
COLUMBIA CITYIN4672510/14/201501/01/2016 02/10/201702/10/2017
Contract DetailWAL-MART PHARMACY 10-1425402 W PLAZA DR
COLUMBIA CITYIN4672507/16/201910/01/2019 12/27/202312/27/2023
Contract DetailWAL-MART PHARMACY 10-1570505 TOURING DR
AUBURNIN4670610/14/201501/01/2016 02/10/201702/10/2017
Contract DetailWAL-MART PHARMACY 10-1570505 TOURING DR
AUBURNIN4670607/16/201910/01/2019 12/27/202312/27/2023
Contract DetailWAL-MART PHARMACY 10-16392395 MAIN STREET
ROCHESTERIN4697510/14/201501/01/2016 02/10/201702/10/2017
Contract DetailWAL-MART PHARMACY 10-16471700 SO. 13TH ST.
DECATURIN4673310/14/201501/01/2016 02/10/201702/10/2017
Contract DetailWAL-MART PHARMACY 10-16671601 N CASS ST
WABASHIN4699210/14/201501/01/2016 02/10/201702/10/2017
Contract DetailWAL-MART PHARMACY 10-17092016 NORTH WAYNE STREET
ANGOLAIN4670310/14/201501/01/2016 02/10/201702/10/2017
Contract DetailWAL-MART PHARMACY 10-17092016 NORTH WAYNE STREET
ANGOLAIN4670307/16/201910/01/2019 12/27/202312/27/2023
Contract DetailWAL-MART PHARMACY 10-17711500 SOUTH CENTERVILLE ROAD
STURGISMI4909110/14/201501/01/2016 02/10/201702/10/2017
Contract DetailWAL-MART PHARMACY 10-18041710 APPLE GLEN BLVD
FORT WAYNEIN4680410/14/201501/01/2016 10/31/201810/31/2018
Contract DetailWAL-MART PHARMACY 10-19782505 NORTH OAK RD
PLYMOUTHIN4656310/14/201501/01/2016 02/10/201702/10/2017
Contract DetailWAL-MART PHARMACY 10-21911215 S. MAIN
BRYANOH4350610/14/201501/01/2016 02/10/201702/10/2017
Contract DetailWAL-MART PHARMACY 10-23112800 WALMART DRIVE
HUNTINGTONIN4675010/14/201501/01/2016 02/10/201702/10/2017
Contract DetailWAL-MART PHARMACY 10-2388950 W VOTAW
PORTLANDIN4737110/14/201501/01/2016 02/10/201702/10/2017
Contract DetailWAL-MART PHARMACY 10-28192100 NO. MAIN STREET
BLUFFTONIN4671410/14/201501/01/2016 02/10/201702/10/2017
Contract DetailWAL-MART PHARMACY 10-423010105 LIMA ROAD
FORT WAYNEIN4681810/14/201501/01/2016 02/10/201702/10/2017
Contract DetailWAL-MART PHARMACY 10-423010105 LIMA ROAD
FORT WAYNEIN4681807/16/201910/01/2019 12/27/202312/27/2023
Contract DetailWAL-MART PHARMACY 10-42317502 SOUTHTOWN CROSSING
FORT WAYNEIN4681610/14/201501/01/2016 10/31/201810/31/2018
Contract DetailWAL-MART PHARMACY 10-42317502 SOUTHTOWN CROSSING
FORT WAYNEIN4681607/16/201910/01/2019 12/27/202312/27/2023
Contract DetailWAL-MART PHARMACY 10-502510420 MAYSVILLE RD
FT WAYNE(E)IN4683510/14/201501/01/2016 10/31/201810/31/2018
Contract DetailWAL-MART PHARMACY 10-502510420 MAYSVILLE RD
FT WAYNE(E)IN4683507/16/201910/01/2019 12/27/202312/27/2023
Contract DetailWAL-MART PHARMACY 10-53152354 COMMERCE PARK DR.
ORLANDOFL3281907/16/201910/01/2019 12/27/202312/27/2023
Contract DetailWAL-MART PHARMACY 10-53851804 NORTH CLINTON STREET
DEFIANCEOH4351210/14/201501/01/2016 02/10/201702/10/2017
Contract DetailWAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283710/14/201501/01/2016 02/10/201702/10/2017
Contract DetailWAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283707/02/201810/01/2018 10/31/201810/31/2018
Contract DetailWAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283707/16/201910/01/2019 12/27/202312/27/2023
Contract DetailWALGREEN CODBA: WALGREENS #11945 11932 LIMA RD
FORT WAYNEIN4681801/26/201704/01/2017  01/26/2017
Contract DetailWALGREEN CODBA: WALGREENS #11494 124 E NORTH STREET
KENDALLVILLEIN4675501/26/201704/01/2017  01/26/2017
Contract DetailWALGREEN CODBA: WALGREENS #12506 1610 W COOK ROAD
FORT WAYNEIN4682501/26/201704/01/2017 04/01/201704/25/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 05115 10412 COLDWATER ROAD
FT WAYNEIN4684501/26/201704/01/2017  01/26/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 03129 6201 STELLHORN ROAD
FT WAYNEIN4681501/26/201704/01/2017  01/26/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 09793 5435 E DUPONT ROAD
FORT WAYNEIN4682501/26/201704/01/2017  01/26/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 05452 2410 N COLISEUM BLVD
FT WAYNEIN4680501/26/201704/01/2017 03/25/202503/25/2025
Contract DetailWALGREEN CO.DBA: WALGREENS # 03502 907 LINCOLN HIGHWAY W
NEW HAVENIN4677401/26/201704/01/2017  01/26/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 09853 10170 MAYSVILLE RD
FT WAYNEIN46835-958901/26/201704/01/2017 03/19/202503/19/2025
Contract DetailWALGREEN CO.DBA: WALGREENS # 05940 5830 N CLINTON ST
FT WAYNEIN4682501/26/201704/01/2017  01/26/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 06868 330 W STATE BLVD
FT WAYNEIN46808-313501/26/201704/01/2017  01/26/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 06673 6202 WEST JEFFERSON BLVD
FT WAYNEIN4680401/26/201704/01/2017  01/26/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 03722 110 E. CREIGHTON AVE.
FT WAYNEIN4680301/26/201704/01/2017  01/26/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 05344 10211 CHESTNUT PLAZA DRIVE
FORT WAYNEIN4681401/26/201704/01/2017  01/26/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 05510 9030 US HIGHWAY 24 W
FT WAYNEIN4680401/26/201704/01/2017  01/26/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 04190 6730 BLUFFTON RD.
FT WAYNEIN4680901/26/201704/01/2017  01/26/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 06066 1804 N JEFFERSON
HUNTINGTONIN4675001/26/201704/01/2017  01/26/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 02932 1701 EAST PAULDING ROAD
FORT WAYNEIN4681601/26/201704/01/2017 02/20/202402/20/2024
Contract DetailWALGREEN CO.DBA: WALGREENS # 07907 535 N LINE ST
COLUMBIA CITYIN46725-122901/26/201704/01/2017 01/28/202501/28/2025
Contract DetailWALGREEN CO.DBA: WALGREENS # 07472 1975 N MAIN ST
BLUFFTONIN46714-118201/26/201704/01/2017  01/26/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 09893 123 N 13TH ST
DECATURIN46733-140901/26/201704/01/2017 04/01/201704/25/2017
Contract DetailWALGREEN CO.DBA: WALGREENS SPECIALTY PHARMACY #16317 335 MASSACHUSETTS AVENUE
INDIANAPOLISIN4620401/26/201704/01/2017  01/26/2017
Contract DetailWALGREEN CO.WALGREENS SPECIALTY PHARMACY #15323 9002 N MERIDIAN ST STE 213
INDIANAPOLISIN4626001/26/201704/01/2017  01/26/2017
Contract DetailWALGREEN CO.DBA: WALGREENS #15148 7950 W JEFFERSON BLVD STE 1B005
FORT WAYNEIN4680401/09/202304/01/2023  04/01/2023
Contract DetailWalgreens Central Fill #213994132Plainfield Rd
Ste 110 		IndianapolisIN46231-702101/09/202304/01/2023  04/01/2023
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #16287 130 ENTERPRISE DR
PITTSBURGHPA1527501/26/201704/01/2017  01/26/2017
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCALLIANCERX WALGREENS PRIME #12314 9775 SW GEMINI DR, STE 1
BEAVERTONOR9700801/26/201704/01/2017 08/31/202112/02/2021
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15438 41460 HAGGERTY CIR S
CANTONMI4818801/26/201704/01/2017  01/26/2017
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15443 10530 JOHN W ELLIOTT DR STE 100
FRISCOTX7503301/26/201704/01/2017  01/26/2017
Contract DetailWALMART PHARMACY 10-51692252 NORTH 8TH STREET
SUITE A 		ROGERSAR7275601/23/202304/01/2023 12/27/202312/27/2023
Contract DetailWHITLEY MEMORIAL HOSPITAL1260 E STATE ROAD 205
COLUMBIA CITYIN46725-949204/11/202407/01/2024  07/01/2024
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
DSH150021AAChildDSHParkview HospitalPRMC WOMENS HEALTH / Rehab-Physical Therapy11104 Parkview Circle Dr STE 50Fort WayneINTerminated
DSH150021ABChildDSHPARKVIEW HOSPITALHOSPICE FORT WAYNE1900 Carew St. Ste 6Fort WayneINTerminated
DSH150021ACChildDSHPARKVIEW HOSPITALHOME CARE FORT WAYNE1900 Carew St. Ste 6Fort WayneINTerminated
DSH150021ADChildDSHParkview HospitalPVH Interventional Radiology2200 Randallia DriveFort WayneINActive
DSH150021AEChildDSHParkview HospitalPVH REHAB PEDS ST OP3439 Hobson RoadFort WayneINTerminated
DSH150021AFChildDSHParkview HospitalREHAB PEDS OT OP3439 Hobson RoadFORT WAYNEINTerminated
DSH150021AGChildDSHParkview HospitalPVH REHAB PEDS PT OP3439 Hobson RoadFORT WAYNEINTerminated
DSH150021AHChildDSHPARKVIEW HOSPITALRANDALLIA ECHO2231 Carew StFORT WAYNEINTerminated
DSH150021AJChildDSHParkview HospitalAnticoagulation clinic / ATU2231 CAREW STFort WayneINTerminated
DSH150021AKChildDSHParkview HospitalPVH REHAB / PHYSICAL THERAPY2200 Randallia DriveFort WayneINActive
DSH150021ALChildDSHParkview HospitalPVH RESPIRATORY2200 Randallia DriveFort WayneINActive
DSH150021AMChildDSHParkview HospitalFWNV1 CT3909 New Vision DriveFORT WAYNEINTerminated
DSH150021ANChildDSHParkview HospitalFWNV1 MRI3909 New Vision DriveFORT WAYNEINActive
DSH150021APChildDSHPARKVIEW HOSPITALFORT WAYNE MRI2110 Carew StFort WayneINTerminated
DSH150021AQChildDSHParkview HospitalPVH PREP/RECOVERY2200 Randallia DriveFort WayneINActive
DSH150021ARChildDSHParkview HospitalPBH INTERMEDIATE SERVICES1720 Beacon StreetFort WayneINTerminated
DSH150021ASChildDSHParkview HospitalPVH Treadmill Stress Test2200 Randallia DriveFort WayneINActive
DSH150021ATChildDSHParkview HospitalPVH Pulmonary Function Test2200 Randallia DriveFort WayneINActive
DSH150021AUChildDSHParkview HospitalPVH Rehab/Speech Therapy2200 Randallia DriveFort WayneINActive
DSH150021AVChildDSHParkview HospitalPVH Rehab/Occupational Therapy2200 Randallia DriveFort WayneINActive
DSH150021AWChildDSHParkview HospitalPVH Rehab/Physical Therapy2200 Randallia DriveFort WayneINTerminated
DSH150021AXChildDSHParkview HospitalPVH OP INFUSION-Observation Beds2200 Randallia DriveFort WayneINActive
DSH150021AYChildDSHParkview HospitalPVH EMERGENCY DEPARTMENT2200 Randallia DriveFort WayneINActive
DSH150021AZChildDSHPARKVIEW HOSPITALPRMC / Nuclear Medicine Outpatient Service Center11109 Parkview Plaza DriveFort WayneINTerminated
DSH150021BChildDSHParkview HospitalFWINV CT8028 CARNEGIE BLVD STE 700FORT WAYNEINTerminated
DSH150021BAChildDSHPARKVIEW HOSPITALPRMC / MRI Outpatient Services11109 Parkview Plaza DriveFort WayneINTerminated
DSH150021BBChildDSHPARKVIEW HOSPITALPVH Continuing Care Center2200 Randallia DriveFort WayneINTerminated
DSH150021BCChildDSHPARKVIEW HOSPITALCT Outpatient Services Center / CT11109 Parkview Plaza DriveFort WayneINTerminated
DSH150021BDChildDSHPARKVIEW HOSPITALParkview Regional Medical Center / Endoscopy11109 Parkview Plaza DriveFort WayneINTerminated
DSH150021BEChildDSHPARKVIEW HOSPITALParkview Regional Medical Center / Rehab-Speech Therapy11109 Parkview Plaza DriveFort WayneINTerminated
DSH150021BFChildDSHPARKVIEW HOSPITALParkview Regional Medical Center / Rehab-Occupational Therapy11109 Parkview Plaza DriveFort WayneINTerminated
DSH150021BGChildDSHPARKVIEW HOSPITALPARKVIEW REGIONAL MEDICAL CENTER REHAB / Physical Therapy11109 Parkview Plaza DriveFort WayneINTerminated
DSH150021BHChildDSHParkview HospitalFWINV ECHOCARDIOGRAPHY8028 Carnegie Blvd STE 700FORT WAYNEINTerminated
DSH150021BJChildDSHParkview HospitalPCI OP Infusion-Observation Beds11050 Parkview Circle Drive STE 3AFort WayneINActive
DSH150021BKChildDSHParkview HospitalPVH CAREW MEDSURG-Observation Beds2200 Randallia DriveFort WayneINActive
DSH150021BLChildDSHParkview HospitalPVH ICU-Observation Beds2200 Randallia DriveFort WayneINActive
DSH150021BMChildDSHParkview HospitalPVH Clinical Decision Unit2200 Randallia driveFort WayneINTerminated
DSH150021BNChildDSHParkview HospitalPVH Family Birthing Center Procedure-Observation Beds2200 Randallia DriveFort WayneINActive
DSH150021BPChildDSHPARKVIEW HOSPITALPVH Randallia MEDSURG2200 Randallia DriveFort WayneINTerminated
DSH150021BQChildDSHParkview HospitalPVH IV Team2200 Randallia DriveFort WayneINTerminated
DSH150021BRChildDSHParkview HospitalPVH Family Birthing-Observation Beds2200 Randallia DriveFot WayneINActive
DSH150021BSChildDSHParkview HospitalPVH Rehab Unit-Observation Beds2200 Randallia DriveFort WayneINActive
DSH150021BTChildDSHParkview HospitalPVH STATE MEDSURG-Observation Beds2200 Randallia DriveFort WayneINActive
DSH150021BUChildDSHParkview HospitalPRMC Center on Aging and Health11104 Parkview Circle Dr STE 40Fort WayneINTerminated
DSH150021BVChildDSHParkview HospitalPVH Bridgeways2200 Randallia DriveFort WayneINTerminated
DSH150021BWChildDSHParkview HospitalPBH Youth-Observation Beds1720 Beacon StreetFort WayneINActive
DSH150021BXChildDSHParkview HospitalPBH NORTH EAST SOUTH WEST-Observation Beds1720 Beacon StreetFort WayneINActive
DSH150021BYChildDSHParkview HospitalPBH Assessment Center1720 BEACON STREETFORT WAYNEINTerminated
DSH150021BZChildDSHParkview HospitalPRMC Ultrasound OSC11141 Parkview Plaza Drive STE 100Fort WayneINActive
DSH150021CChildDSHParkview HospitalPVH CV NUCLEAR MEDICINE2200 Randallia DrFort WayneINActive
DSH150021CAChildDSHParkview HospitalPRMC Rapid Diagnostic Unit-Observation Beds11104 Parkview Circle Dr Suite 210Fort WayneINActive
DSH150021CBChildDSHParkview HospitalPVH CARDIAC REHAB2200 Randallia DriveFort WayneINActive
DSH150021CCChildDSHParkview HospitalPVH CHRONIC PAIN PARTIAL HOSPITALIZATION2200 Randallia DriveFort WayneINActive
DSH150021CDChildDSHParkview HospitalPCI ULTRASOUND11050 Parkview Circle Drive STE 1CFORT WAYNEINActive
DSH150021CEChildDSHParkview HospitalPCI CT11050 Parkview Circle Drive STE 1Cfort wayneINActive
DSH150021CFChildDSHParkview HospitalPBH PHYSICAL THERAPY1720 BEACON STREETFORT WAYNEINTerminated
DSH150021CGChildDSHParkview HospitalPVH ULTRASOUND2200 Randallia DriveFORT WAYNEINActive
DSH150021CHChildDSHParkview HospitalPCI DIAGNOSTIC IMAGING11050 Parkview Circle DriveFORT WAYNEINTerminated
DSH150021CJChildDSHParkview HospitalPRMC PHI HEART FAILURE CLINIC11108 PARKVIEW CIRCLE DRFORT WAYNEINTerminated
DSH150021CKChildDSHParkview HospitalPBH REHAB/OCCUPATIONAL THERAPY1720 BEACON STREETFORT WAYNEINTerminated
DSH150021CLChildDSHParkview HospitalPRMC PREOP CLINIC OSC-Observation Beds11143 Parkview Plaza DriveFORT WAYNEINActive
DSH150021CMChildDSHParkview HospitalPVH HEART FAILURE CLINIC2200 Randallia DriveFORT WAYNEINTerminated
DSH150021CNChildDSHParkview HospitalPVH CATH LAB2200 Randallia DriveFORT WAYNEINActive
DSH150021CPChildDSHParkview HospitalPVH SUPPORTIVE CARE UNIT2200 Randallia DriveFORT WAYNEINTerminated
DSH150021CQChildDSHParkview HospitalPVH SLEEP LAB2200 Randallia DriveFORT WAYNEINActive
DSH150021CRChildDSHParkview HospitalPVH INFECTIOUS DISEASE2231 CAREW STFORT WAYNEINActive
DSH150021CSChildDSHParkview HospitalPVH HOLTER MON AND EVENT RECORDING2200 Randallia DriveFORT WAYNEINTerminated
DSH150021CTChildDSHParkview HospitalPRMC EEG PEDS11123 PARKVIEW PLAZA DR STE 202FORT WAYNEINTerminated
DSH150021CUChildDSHParkview HospitalPRMC INFECTIOUS DISEASE11104 PARKVIEW CIRCLE DRIVE STE 440FORT WAYNEINActive
DSH150021CVChildDSHParkview HospitalFWNV1 ULTRASOUND3909 NEW VISION DRFORT WAYNEINActive
DSH150021CWChildDSHParkview HospitalPRMC ENDOSCOPY11104 PARKVIEW CIRCLE DR STE 220FORT WAYNEINActive
DSH150021CXChildDSHParkview HospitalPVH EEG2200 Randallia DriveFORT WAYNEINActive
DSH150021CYChildDSHParkview HospitalPREMIER SURGERY OPERATING ROOM11141 Parkview Plaza Dr STE 200FORT WAYNEINActive
DSH150021CZChildDSHParkview HospitalPCI MRI11050 Parkview Circle Drive STE 1CFORT WAYNEINActive
DSH150021DChildDSHParkview HospitalPVH CT2200 Randallia DrFort WayneINActive
DSH150021DAChildDSHParkview HospitalPRMC ECHO PEDS11123 PARKVIEW PLAZA DR STE 202FORT WAYNEINActive
DSH150021DBChildDSHParkview HospitalPRMC PEDS OP INFUSION11123 PARKVIEW PLAZA DR STE 202FORT WAYNEINActive
DSH150021DCChildDSHParkview HospitalPVH DIAGNOSTIC IMAGING2200 Randallia DriveFORT WAYNEINTerminated
DSH150021DDChildDSHParkview HospitalPRMC DIAGNOSTIC IMAGING OSC11141 PARKVIEW PLAZA DRIVE STE 200FORT WAYNEINTerminated
DSH150021DEChildDSHParkview HospitalPBH NUTRITION1720 BEACON STREETFORT WAYNEINTerminated
DSH150021DFChildDSHParkview HospitalPCI MAMMOGRAPHY11050 Parkview Circle Drive STE 4AFORT WAYNEINActive
DSH150021DGChildDSHParkview HospitalPRMC RHEUMATOLOGY11143 Parkview Plaza Drive STE 200FORT WAYNEINActive
DSH150021DHChildDSHParkview HospitalPREMIER SURGERY PACU11141 PARKVIEW PLAZA DRIVE STE 200FORT WAYNEINActive
DSH150021DJChildDSHParkview HospitalPVH EKG2200 Randallia DriveFORT WAYNEINActive
DSH150021DKChildDSHParkview HospitalFWINV DIAGNOSTIC IMAGING8028 CARNEGIE BLVD STE 700FORT WAYNEINTerminated
DSH150021DLChildDSHParkview HospitalPRMC HOLTER MONITOR PEDS11123 PARKVIEW PLAZA DR STE 202FORT WAYNEINTerminated
DSH150021DMChildDSHParkview HospitalPREMIER SURGERY PREP/RECOVERY11141 PARKVIEW PLAZA DRIVE STE 200FORT WAYNEINActive
DSH150021DNChildDSHParkview HospitalPVH ENGLISH PROGRESSIVE-Observation Beds2200 Randallia DriveFORT WAYNEINActive
DSH150021DPChildDSHParkview HospitalFWNV1 DIAGNOSTIC IMAGING3909 NEW VISION DRFORT WAYNEINTerminated
DSH150021DQChildDSHParkview HospitalPVH 2 SURGICAL-Observation Beds2200 Randallia DriveFort WayneINActive
DSH150021DRChildDSHParkview HospitalPRMC EEG OSC11141 PARKVIEW PLAZA DRFort WayneINTerminated
DSH150021DSChildDSHParkview HospitalPRMC W & C ADVANCED PERINATAL CARE CENTER-Observation Beds11123 PARKVIEW PLAZA DR STE 204FORT WAYNEINActive
DSH150021DTChildDSHParkview HospitalPVH 4 Medical-Observation Beds2200 Randallia DriveFORT WAYNEINActive
DSH150021DUChildDSHParkview HospitalPVH MEDSURGE EXTENDED - MedSurge Extended2200 Randallia DriveFort WayneINTerminated
DSH150021DVChildDSHParkview HospitalPVH PULMONARY REHAB - Pulm Rehab2200 Randallia DriveFort WayneINActive
DSH150021DWChildDSHParkview HospitalPVH Ostomy Clinic - Clinic2200 Randallia DriveFort WayneINActive
DSH150021DXChildDSHParkview HospitalPVH 7 MEDICAL-Outpatient Observation Beds - Clinic2200 Randallia DriveFort WayneINTerminated
DSH150021DYChildDSHParkview HospitalPVH 5 MEDICAL-Observation Beds2200 Randallia DriveFort WayneINActive
DSH150021DZChildDSHParkview HospitalPVH SURGE MEDSURG EXTENDED-Observation Beds2200 Randallia DriveFort WayneINActive
DSH150021EChildDSHParkview HospitalPVH NUCLEAR MEDICINE2200 Randallia DrFort WayneINActive
DSH150021EAChildDSHParkview HospitalPVH Lab - Lab2200 Randallia DrFort WayneINTerminated
DSH150021EBChildDSHParkview HospitalPRMC Lab - OSC11141 Parkview Plaza DriveFort WayneINTerminated
DSH150021ECChildDSHParkview HospitalPARKVIEW REG MED CENTER LAB - PCI Lab11050 PARKVIEW CIRCLE DRFORT WAYNEINTerminated
DSH150021EDChildDSHParkview HospitalPRMC MRI OSC - Radiology11141 Parkview Plaza Drive STE 100Fort WayneINActive
DSH150021EEChildDSHParkview HospitalPRMC NUCLEAR MEDICINE OSC - Radiology11141 Parkview Plaza Drive STE 100Fort WayneINActive
DSH150021EFChildDSHParkview HospitalPRMC CT OSC - Radiology11141 Parkview Plaza Drive STE 100Fort WayneINActive
DSH150021EGChildDSHParkview HospitalFWNV1 DIAG IMAGING - Radiology3909 New Vision DrFort WayneINTerminated
DSH150021EHChildDSHParkview HospitalPRMC LAB WAUSEON 725 SHOOP - Lab725 S Shoop AveWauseonOHTerminated
DSH150021EJChildDSHParkview HospitalPBH IOP CD - Partial Hospitalization1720 Beacon StreetFort WayneINActive
DSH150021EKChildDSHParkview HospitalNORTH CLINTON 5110 LAB - Lab5110 N. ClintonFort WayneINTerminated
DSH150021ELChildDSHParkview HospitalFWINV PEDIATRIC ECHOCARDIOGRAPHY - Radiology8028 Carnegie Blvd, Suite 700Fort WayneINActive
DSH150021EMChildDSHParkview HospitalFWLM DIAG IMAGING - Radiology8911 Liberty Mills Rd, Ste 200Fort WayneINTerminated
DSH150021ENChildDSHParkview HospitalPRMC LAB MONTPELIER - Lab935 Snyder AveMontpelierOHTerminated
DSH150021EPChildDSHParkview HospitalNHMR DIAG IMAGING - Radiology1331 Minnich RoadNew HavenINTerminated
DSH150021EQChildDSHParkview HospitalPRMC EEG OP - Electroencephalography11104 Parkview Circle Dr Suite 040Fort WayneINActive
DSH150021ERChildDSHParkview HospitalPVH HOLTER MON AND EVENT RECORDING - Echocardiology2200 Randallia DriveFort WayneINActive
DSH150021ESChildDSHParkview HospitalPVH PULMONARY REHAB - Respiratory Therapy2200 Randallia DriveFort WayneINTerminated
DSH150021ETChildDSHParkview HospitalST JOE CTR LAB - Lab5693 YMCA Park Drive WestFort WayneINTerminated
DSH150021EUChildDSHParkview HospitalFWLM LAB - Lab8911 Liberty Mills Rd, Ste 200Fort WayneINTerminated
DSH150021EVChildDSHParkview HospitalCAREW MEDICAL PARK LAB - Lab1818 Carew StreetFort WayneINTerminated
DSH150021EWChildDSHParkview HospitalPBH IOP MH - Observation Beds1720 Beacon StreetFort WayneINActive
DSH150021EXChildDSHParkview HospitalFWNV1 LAB - Lab3909 New Vision DrFort WayneINTerminated
DSH150021EYChildDSHParkview HospitalPVH REHAB PEDS NUTRITION - Nutrition Support3439 Hobson RoadFort WayneINActive
DSH150021EZChildDSHParkview HospitalWAYNEDALE TEMPLE LAB - Lab8607 Temple Dr.Fort WayneINTerminated
DSH150021FChildDSHParkview HospitalPVH MRI2200 Randallia DrFort WayneINActive
DSH150021FAChildDSHParkview HospitalPRMC LAB ARCHBOLD - Lab121 Westfield DrArchboldOHTerminated
DSH150021FBChildDSHParkview HospitalPARKVIEW NEUROSCIENCES MULTISPECIALTY CLINIC - Neuro Rehab11104 Parkview Circle Dr Suite 040Fort WayneINActive
DSH150021FCChildDSHParkview HospitalPVH 6 EAST - Observation Beds2200 Randallia DriveFort WayneINActive
DSH150021FDChildDSHParkview HospitalPRMC DIABETES ED - Clinic11143 Parkview Plaza Dr, Suite 110Fort WayneINActive
DSH150021FEChildDSHParkview HospitalLIMA ROAD CLINIC LAB - Lab11055 Twin Creeks CoveFort WayneINTerminated
DSH150021FFChildDSHParkview HospitalPVH DIAG IMAGING - Radiology2200 Randallia DriveFort WayneINTerminated
DSH150021FGChildDSHParkview HospitalPRMC DIAG IMAGING OSC - Radiology11141 Parkview Plaza Drive,Entrance 3Fort WayneINTerminated
DSH150021FHChildDSHParkview HospitalPVH ED OUTPATIENTS - Emergency Infusion2200 Randallia DriveFort WayneINActive
DSH150021FJChildDSHParkview HospitalPRMC MOB2 OBGYN LAB - Lab11123 Parkview Plaza DrFort WayneINTerminated
DSH150021FKChildDSHParkview HospitalFWINV LAB - Lab8028 Carnegie Blvd, Suite 160Fort WayneINTerminated
DSH150021FLChildDSHParkview HospitalPRMC PEDS DEV CARE CENTER OSC - Clinic11141 Parkview Plaza Dr Suite 210Fort WayneINActive
DSH150021FMChildDSHParkview HospitalGRABILL MAIN LAB - Lab13430 Main StreetGrabillINTerminated
DSH150021FNChildDSHParkview HospitalPVH 3 STATE - Observation Beds2200 Randallia DriveFort WayneINActive
DSH150021FPChildDSHParkview HospitalFWINV DIAG IMAGING - Radiology8028 Carnegie Blvd, Suite 700Fort WayneINTerminated
DSH150021FQChildDSHParkview HospitalPCI DIAG IMAGING - Radiology11050 Parkview Circle, Entrance 12Fort WayneINTerminated
DSH150021FRChildDSHParkview HospitalPRMC LAB BRYAN - Lab442 West High StreetBryanOHTerminated
DSH150021FSChildDSHParkview HospitalNHMR LAB - Lab1331 Minnich RoadNew HavenINTerminated
DSH150021FTChildDSHParkview HospitalPRMC PEDIATRIC HEMATOLOGY ONCOLOGY - Observation Beds11104 Parkview Circle Dr Suite 050Fort WayneINActive
DSH150021FUChildDSHParkview HospitalPVH 6 SOUTH - Observation Beds2200 Randallia DriveFort WayneINActive
DSH150021FVChildDSHParkview HospitalPRMC PEDIATRIC HEMATOLOGY ONCOLOGY INFUSION - Lab11104 Parkview Circle Dr Suite 050Fort WayneINActive
DSH150021FWChildDSHParkview HospitalPFCI ONC THORACIC LUNG - Oncology11050 Parkview CircleFort WayneINActive
DSH150021FXChildDSHParkview HospitalPSW PFCI UPPER AND LOWER GI - GASTROENTEROLOGY8202 GLENCARIN BLVDFort WayneINActive
DSH150021FYChildDSHParkview HospitalPSW MAMMOGRAPHY - IMAGING8202 GLENCARIN BLVDFort WayneINActive
DSH150021FZChildDSHParkview HospitalPFCI REHAB OT OP HOD - Oncology11050 Parkview CircleFort WayneINActive
DSH150021GChildDSHPARKVIEW HOSPITALPVH EMERGENCY DEPT2200 Randallia DrFort WayneINTerminated
DSH150021GAChildDSHParkview HospitalPFCI PULMONOLOGY - Oncology11050 Parkview CircleFort WayneINActive
DSH150021GBChildDSHParkview HospitalPSW DIAG IMAGING - IMAGING8202 GLENCARIN BLVDFort WayneINTerminated
DSH150021GCChildDSHParkview HospitalPSW RESPIRATORY - RESPIRATORY THERAPY8202 GLENCARIN BLVDFort WayneINActive
DSH150021GDChildDSHParkview HospitalPFCI ONC GENITOURINARY - Oncology11050 Parkview CircleFort WayneINActive
DSH150021GEChildDSHParkview HospitalPRMC NEURO SURGERY - Neurology11104 PARKVIEW CIRCLE DR STE 110Fort WayneINActive
DSH150021GFChildDSHParkview HospitalGLENCARIN LAB - Laboratory8233 Glencarin BlvdFort WayneINTerminated
DSH150021GGChildDSHParkview HospitalPFCI ONC SARCOMA - Oncology11050 Parkview CircleFort WayneINActive
DSH150021GHChildDSHParkview HospitalPSW ECHO - RADIOLOGY-DIAGNOSTIC8202 GLENCARIN BLVDFort WayneINActive
DSH150021GJChildDSHParkview HospitalPFCI ONC MEDICAL ONCOLOGY/HEMATOLOGY - Oncology11050 Parkview CircleFort WayneINActive
DSH150021GKChildDSHParkview HospitalPRMC NEUROINTERVENTION - Neurology11104 PARKVIEW CIRCLE DR STE 110Fort WayneINActive
DSH150021GLChildDSHParkview HospitalPSW MRI - IMAGING8202 GLENCARIN BLVDFort WayneINActive
DSH150021GMChildDSHParkview HospitalPSW STRESS TREADMILL - RESPIRATORY THERAPY8202 GLENCARIN BLVDFort WayneINActive
DSH150021GNChildDSHParkview HospitalPSW ENDOCRINOLOGY - Endocrinology8202 GLENCARIN BLVDFort WayneINActive
DSH150021GPChildDSHParkview HospitalPSW CT - IMAGING8202 GLENCARIN BLVDFort WayneINActive
DSH150021GQChildDSHParkview HospitalPFCI ONC UPPER AND LOWER GI - Oncology11050 Parkview CircleFort WayneINActive
DSH150021GRChildDSHParkview HospitalPRMC OSC Endocrinology - Endocrinology11141 PARKVIEW PLAZA DR STE 310Fort WayneINActive
DSH150021GSChildDSHParkview HospitalPFCI REHAB ST OP - Oncology11050 Parkview CircleFort WayneINActive
DSH150021GTChildDSHParkview HospitalPSW PFCI GYN - Oncology8202 GLENCARIN BLVDFort WayneINActive
DSH150021GUChildDSHParkview HospitalPFCI ONC GYN - Oncology11050 Parkview CircleFort WayneINActive
DSH150021GVChildDSHParkview HospitalPSW RHEUMATOLOGY - RHEUMATOLOGY8202 GLENCARIN BLVDFort WayneINActive
DSH150021GWChildDSHParkview HospitalPSW PULMONARY FUNCTION TEST - RESPIRATORY THERAPY8202 GLENCARIN BLVDFort WayneINActive
DSH150021GXChildDSHParkview HospitalPFCI ONC HIGH RISK - Oncology11050 Parkview CircleFort WayneINActive
DSH150021GYChildDSHParkview HospitalPSW GI - GASTROENTEROLOGY8202 GLENCARIN BLVDFort WayneINActive
DSH150021GZChildDSHParkview HospitalPSW NEURO - Neurology8202 GLENCARIN BLVDFort WayneINActive
DSH150021HChildDSHParkview HospitalPVH PACU2200 Randallia DrFort WayneINActive
DSH150021HAChildDSHParkview HospitalPSW ULTRASOUND - IMAGING8202 GLENCARIN BLVDFort WayneINActive
DSH150021HBChildDSHParkview HospitalELECTRIC WORKS LAB - Laboratory1660 Broadway St Suite 165Fort WayneINTerminated
DSH150021HCChildDSHParkview HospitalPSW EMERGENCY DEPT - EMERGENCY8202 GLENCARIN BLVDFort WayneINActive
DSH150021HDChildDSHParkview HospitalPSW SLEEP LAB - RESPIRATORY THERAPY8202 GLENCARIN BLVDFort WayneINActive
DSH150021HEChildDSHParkview HospitalPRMC Gastroenterology - GI11104 Parkview Circle Dr Suite 440Fort WayneINActive
DSH150021HFChildDSHParkview HospitalPSW EKG - RESPIRATORY THERAPY8202 GLENCARIN BLVDFort WayneINActive
DSH150021HGChildDSHParkview HospitalPSW PFCI MEDICAL ONCOLOGY/HEMATOLOGY - Oncology8202 GLENCARIN BLVDFort WayneINActive
DSH150021HHChildDSHParkview HospitalPFCI ONC PALCARE - Oncology11050 Parkview CircleFort WayneINActive
DSH150021HJChildDSHParkview HospitalPRMC NEURO - Neurology11104 PARKVIEW CIRCLE DR STE 110Fort WayneINActive
DSH150021HKChildDSHParkview HospitalPFCI ONC BREAST - Oncology11050 Parkview CircleFort WayneINActive
DSH150021HLChildDSHParkview HospitalPFCI REHAB PT OP HOD - Oncology11050 Parkview CircleFort WayneINActive
DSH150021HMChildDSHParkview HospitalPSW LAB - Laboratory8202 GLENCARIN BLVDFort WayneINTerminated
DSH150021HNChildDSHParkview HospitalPSW PFCI BREAST - Oncology8202 GLENCARIN BLVDFort WayneINActive
DSH150021HPChildDSHParkview HospitalPSW URO - UROLOGY8202 GLENCARIN BLVDFort WayneINActive
DSH150021HQChildDSHParkview HospitalPSW HOLTER MON AND EVENT REC - RESPIRATORY THERAPY8202 GLENCARIN BLVDFort WayneINActive
DSH150021HRChildDSHParkview HospitalPBH ASSESSMENT CENTER - Psychiatry1720 Beacon StreetFort WayneINActive
DSH150021HSChildDSHParkview HospitalPEDS NUTRITION DEV CARE CENTER - Nutrition11141 Parkview Plaza DrFort WayneINActive
DSH150021HTChildDSHParkview HospitalPRMC PEDS DEV CARE CENTER SPEECH THERAPY - Developmental and Behavioral Pediatrics11141 PARKVIEW PLAZA DRFort WayneINActive
DSH150021HUChildDSHParkview HospitalPVH OR ENDO - General Surgery2200 Randallia DriveFort WayneINActive
DSH150021HVChildDSHParkview HospitalPVH PERFUSION - Operating Room2200 Randallia DriveFort WayneINActive
DSH150021HWChildDSHParkview HospitalPVH PREOP CLINIC - Pre-Admission Testing2200 Randallia DriveFort WayneINActive
DSH150021HXChildDSHParkview HospitalPVH PREP/RECOVERY EXTENDED - EMERGENCY2200 Randallia DriveFort WayneINActive
DSH150021HYChildDSHParkview HospitalPVH REHAB PEDS OT OP - Occupational Therapy3439 Hobson RoadFort WayneINActive
DSH150021HZChildDSHParkview HospitalPVH REHAB PEDS PT OP - Physical Therapy3439 Hobson RoadFort WayneINActive
DSH150021JChildDSHParkview HospitalPVH FLOUROSCOPY2200 Randallia DrFort WayneINActive
DSH150021JAChildDSHParkview HospitalPVH REHAB PEDS ST OP - Speech Therapy3439 Hobson RoadFort WayneINActive
DSH150021JBChildDSHParkview HospitalRUDISILL LAB - Laboratory1007 W. Rudisill BlvdFort WayneINTerminated
DSH150021JCChildDSHParkview HospitalPBH LAB - Laboratory1720 Beacon StreetFort WayneINTerminated
DSH150021JDChildDSHParkview HospitalNORTH CLINTON LAB - Laboratory5104 N. ClintonFort WayneINTerminated
DSH150021JEChildDSHParkview HospitalPRMC OSC PEDS LAB - Laboratory11141 Parkview Plaza Dr Ste 210Fort WayneINTerminated
DSH150021JFChildDSHParkview HospitalPRMC HOLTER MONITOR PEDS MP2 - Cardiology11123 Parkview Plaza Dr Ste 202Fort WayneINActive
DSH150021JGChildDSHParkview HospitalPRMC CANCER INSTITUTE LAB - Laboratory11104 Parkview Circle Dr.Fort WayneINTerminated
DSH150021JHChildDSHParkview HospitalPVH REHAB/Physical Therapy Outpatient - Physical Therapy2200 Randallia DriveFort WayneINActive
DSH150021JJChildDSHParkview HospitalPVH LAB PARKVIEW HEART INSTITUTE - Laboratory2200 Randallia DriveFort WayneINTerminated
DSH150021JKChildDSHParkview HospitalPVH REHAB/Occupational Therapy Outpatient - Occupational Therapy2200 Randallia DriveFort WayneINActive
DSH150021JLChildDSHParkview HospitalWOODLAND PLAZA WEIGHT MANAGEMENT - Weight Management1234 E DUPONT RD STE 1Fort WayneINTerminated
DSH150021JMChildDSHParkview HospitalPVH REHAB ST OP - Neuro Rehab2200 Randallia DriveFort WayneINActive
DSH150021JNChildDSHParkview HospitalPRMC 1ST FLOOR STRESS TREADMILL - Radioisotope11108 Parkview Circle DriveFort WayneINActive
DSH150021JPChildDSHParkview HospitalPRMC ULTRASOUND PHI - Radiology11108 Parkview Circle DriveFort WayneINActive
DSH150021JQChildDSHParkview HospitalPRMC 1ST FLOOR CV NUCLEAR MEDICINE - Radiology11108 Parkview Circle DriveFort WayneINActive
DSH150021JRChildDSHParkview HospitalWOODLAND PLAZA INFECTIOUS DISEASE - Infectious Disease1234 E DUPONT RD STE 5Fort WayneINActive
DSH150021JSChildDSHParkview HospitalPRMC PREMIER ENDO - Endoscopy11141 Parkview Plaza DriveFort WayneINActive
DSH150021JTChildDSHParkview HospitalPRMC 1ST FLOOR PHI ECHOCARDIOGRAPHY - Radiology11108 Parkview Circle DriveFort WayneINActive
DSH150021JVChildDSHParkview HospitalPSW AAI - Allergy and Asthma8202 GLENCARIN BLVDFort WayneINActive
DSH150021JWChildDSHParkview HospitalPVH CMMC - Anticoag2231 CAREW STFort WayneINActive
DSH150021JXChildDSHParkview HospitalPRMC AAI - Allergy and Asthma11104 PARKVIEW CIRCLE DR STE 10Fort WayneINActive
DSH150021JYChildDSHParkview HospitalPRMC PULMONOLOGY - Pulmonology11104 PARKVIEW CIRCLE DR STE 410Fort WayneINActive
DSH150021JZChildDSHParkview HospitalPVH REHAB UNIT 2-OBSERVATION BEDS - Rehab Observation Beds2200 Randallia DriveFort WayneINActive
DSH150021KChildDSHParkview HospitalPVH OPERATING ROOM2200 Randallia DrFort WayneINActive
DSH150021LChildDSHParkview HospitalPVH WOUND CARE2200 Randallia DrFort WayneINActive
DSH150021MChildDSHParkview HospitalPVH ENDOSCOPY2200 Randallia DrFort WayneINActive
DSH150021NChildDSHParkview HospitalPVH NUTRITION2200 Randallia DrFort WayneINActive
DSH150021PChildDSHPARKVIEW HOSPITALMedical Oncology 11143 Parkview Plaza DriveFort WayneINTerminated
DSH150021QChildDSHPARKVIEW HOSPITALRegional Cancer Center / cancer services11141 Parkview Plaza Dr., Ste 110Fort WayneINTerminated
DSH150021RChildDSHParkview HospitalPCI RADIATION ONC11050 Parkview Circle Drive STE 1AFort WayneINActive
DSH150021SChildDSHParkview HospitalPVH CENTER FOR WOUND HEALING2200 Randallia DrFort WayneINActive
DSH150021TChildDSHParkview HospitalPCI GENETIC COUNSELING11050 Parkview Circle Drive STE 1DFort WayneINTerminated
DSH150021UChildDSHParkview HospitalPVH ECHOCARDIOGRAPHY2200 Randallia DrFort WayneINActive
DSH150021VChildDSHParkview HospitalPVH DIALYSIS2200 Randallia DrFort WayneINActive
DSH150021WChildDSHPARKVIEW HOSPITALPVH REHAB / Occupational Therapy2200 Randallia DrFort WayneINTerminated
DSH150021XChildDSHParkview HospitalREHAB PEDS NUTRITION3439 Hobson RoadFort WayneINTerminated
DSH150021YChildDSHPARKVIEW HOSPITALPVH REHAB / Speech Therapy2200 Randallia DrFort WayneINTerminated
DSH150021ZChildDSHParkview HospitalPVH DIABETES ED2200 Randallia DrFort WayneINActive
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
Medicaid BillingNPI: NumberInsertGroup Change Request 12753053443/15/2025 10:55 AM
Medicaid BillingNPI: StateInsertGroup Change Request IN3/15/2025 10:55 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 12753053443/15/2025 10:55 AM
Medicaid BillingNPI: StateInsertGroup Change Request MI3/15/2025 10:55 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 12753053443/15/2025 10:55 AM
Medicaid BillingNPI: StateInsertGroup Change Request OH3/15/2025 10:55 AM
AddressesShipping AddressInsertChange Request Parkview Home Infusion Services 1450 Production Rd STE 100 Fort Wayne, IN 4680811/20/2024 7:56 AM
AddressesShipping AddressUpdateChange RequestParkview Hospital Pharmacy 2200 Randallia Fort Wayne, IN 46805Parkview Hospital Pharmacy 2200 Randallia Drive Fort Wayne, IN 4680511/13/2024 6:50 AM
DetailsLast Recertification DateUpdateRecertification8/16/2023 1:33:55 PM8/14/2024 2:12:35 PM8/14/2024 2:12 PM
AddressesShipping AddressInsertChange Request Parkview Integrated Pharmacy 1450 Production Road STE 400 Fort Wayne, IN 468088/8/2024 7:44 AM
ContactsAuthorizing OfficialUpdateChange RequestWickens, Jeanne CFO Parkview Health 2603738407Risser, Stanton Assoc Chief Financial Officer Parkview Health System 26026693137/29/2024 4:18 PM
AddressesShipping AddressUpdateChange RequestParkview Southwest Surgery Center Pharmacy 8202 Glencarin Boulevard Fort Wayne, IN 46804Parkview Southwest Outpatient Center Pharmacy 8202 Glencarin Boulevard Fort Wayne, IN 468045/17/2024 6:40 AM
AddressesShipping AddressUpdateChange RequestElectric Works Pharmacy 1660 Broadway St Fort Wayne, IN 46802Electric Works Pharmacy 1660 Broadway St., STE 165 Fort Wayne, IN 468025/16/2024 7:18 AM
AddressesShipping AddressInsertChange Request Parkview Southwest Surgery Center Pharmacy 8202 Glencarin Boulevard Fort Wayne, IN 468041/26/2024 7:34 AM
AddressesShipping AddressInsertChange Request Electric Works Pharmacy 1660 Broadway St Fort Wayne, IN 468021/26/2024 7:34 AM
DetailsLast Recertification DateUpdateRecertification9/7/2022 12:02:09 PM8/16/2023 1:33:55 PM8/16/2023 1:33 PM
DetailsLast Recertification DateUpdateRecertification8/17/2021 10:15:57 AM9/7/2022 12:02:09 PM9/7/2022 12:02 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False5/17/2022 6:02 PM
Medicaid BillingMedicaid: NumberInsertChange Request 67232825/17/2022 6:02 PM
Medicaid BillingMedicaid: StateInsertChange Request OH5/17/2022 6:02 PM
AddressesShipping AddressInsertChange Request Medical Park 11 Pharmacy 11104 Parkview Circle Dr Fort Wayne, IN 468453/2/2022 3:05 PM
AddressesShipping AddressInsertChange Request Parkview Randallia Outpatient Pharmacy 2200 Randallia Drive Fort Wayne, IN 468053/2/2022 3:05 PM
DetailsComments PublicInsertChange Request Does Parkview Hospital own Medical Park 11 Pharmacy and Parkview Randallia Outpatient Pharmacy? Please reply in the comment section and return. Thank you.2/22/2022 7:54 AM
DetailsLast Recertification DateUpdateRecertification8/20/2020 6:11:32 PM8/17/2021 10:15:57 AM8/17/2021 10:15 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False6/4/2021 8:54 AM
Medicaid BillingMedicaid: NumberInsertChange Request 100268480A6/4/2021 8:54 AM
Medicaid BillingMedicaid: StateInsertChange Request IN6/4/2021 8:54 AM
Medicaid BillingNPI: NumberInsertChange Request 13664076036/4/2021 8:54 AM
Medicaid BillingNPI: StateInsertChange Request IN6/4/2021 8:54 AM
Medicaid BillingNPI: NumberInsertChange Request 13664076036/4/2021 8:54 AM
Medicaid BillingNPI: StateInsertChange Request OH6/4/2021 8:54 AM
Medicaid BillingNPI: NumberInsertChange Request 13664076036/4/2021 8:54 AM
Medicaid BillingNPI: StateInsertChange Request MI6/4/2021 8:54 AM
DetailsLast Recertification DateUpdateRecertification8/26/2019 7:49:50 AM8/20/2020 6:11:32 PM8/20/2020 6:11 PM
AddressesShipping AddressInsertRecertification PARKVIEW REGIONAL MEDICAL CENTER PHARMACY 11109 Parkview Plaza Drive fort wayne, IN 468458/26/2019 7:49 AM
AddressesShipping AddressDeleteRecertificationParkview North Pharmacy 11109 Parkview Plaza Drive fort wayne, IN 46845 8/26/2019 7:49 AM
DetailsLast Recertification DateUpdateRecertification8/22/2018 11:27:44 AM8/26/2019 7:49:50 AM8/26/2019 7:49 AM
DetailsEntity NameUpdateChange RequestParkview Regional Medical CenterParkview Hospital7/18/2019 11:41 AM
DetailsEntity NameUpdateChange RequestPARKVIEW HOSPITALParkview Regional Medical Center7/16/2019 11:00 AM
ContactsPrimary ContactUpdateProfile Change RequestDickmeyer, Stephanie 340B Program Coordinator Parkview Health 2602664408Dickmeyer, Stephanie 340B Program Supervisor Parkview Health 26026644081/28/2019 7:57 AM
AddressesShipping AddressDeleteChange RequestParkview Home Infusion Services 1900 Carew St. Ste 4 fort wayne, IN 46805 11/15/2018 9:15 AM
DetailsLast Recertification DateUpdateRecertification11/15/2017 8:54:17 PM8/22/2018 11:27:44 AM8/22/2018 11:27 AM
AddressesShipping AddressInsertChange Request Parkview Home Infusion Services 1900 Carew St. Ste 4 fort wayne, IN 4680511/28/2017 1:22 PM
DetailsLast Recertification DateUpdateRecertification8/12/2016 12:00:00 AM11/15/2017 8:54:17 PM11/15/2017 8:54 PM
ContactsAuthorizing OfficialUpdate Wickens, Jeanne CFO 2603738407Wickens, Jeanne CFO Parkview Health 260373840710/10/2017 9:37 AM
ContactsPrimary ContactUpdate Dickmeyer, Stephanie 340B Program Coordinator 2602664408Dickmeyer, Stephanie 340B Program Coordinator Parkview Health 260266440810/4/2017 11:10 AM
ContactsAuthorizing OfficialInsert  Wickens, Jeanne CFO 26037384078/9/2017 12:48 PM
ContactsPrimary ContactUpdate CMELIK, TIM CORPORATE DIRECTOR OF PHARMACY 2603733453Dickmeyer, Stephanie 340B Program Coordinator 26026644085/31/2017 2:55 PM
ContactsSigned ByInsert  Browning, Michael P. Senior Vice President and Chief Financial Officer 26037384075/31/2017 2:54 PM
AddressesShipping AddressDelete Home Infusion 1900 Carew St. Ste 4 fort wayne, IN 46805 5/23/2017 11:40 AM
AddressesMain AddressInsert   11109 PARKVIEW PLAZA DRIVE FORT WAYNE, IN 468455/23/2017 11:40 AM
AddressesBilling AddressInsert  Parkview Memorial Hospital, Inc 2200 Randallia Dr Fort Wayne, IN 468055/23/2017 11:40 AM
AddressesShipping AddressInsert  Home Infusion 1900 Carew St. Ste 4 fort wayne, IN 468055/23/2017 11:40 AM
AddressesShipping AddressInsert  Parkview Hospital Pharmacy 2200 Randallia Fort Wayne, IN 468055/23/2017 11:40 AM
AddressesShipping AddressInsert  Parkview Behavioral Health Pharmacy 1720 Beacon St Fort Wayne, IN 468055/23/2017 11:40 AM
AddressesShipping AddressInsert  Parkview Distribution Center 1450 Production Road fort wayne, IN 468085/23/2017 11:40 AM
AddressesShipping AddressInsert  Parkview North Pharmacy 11109 Parkview Plaza Drive fort wayne, IN 468455/23/2017 11:40 AM
DetailsLast Recertification DateUpdate  8/12/2016 12:00:00 AM8/13/2016 7:48 AM
DetailsLast Recertification DateUpdate 9/10/2013 12:00:00 AM 8/31/2015 1:52 PM
DatesLast Date That 340B Drugs PurchasedUpdate 6/2/2014 12:00:00 AM 8/31/2015 1:52 PM
DatesParticipating Approval DateUpdate 3/16/2011 12:00:00 AM8/31/2015 12:00:00 AM8/31/2015 1:52 PM
DetailsStateUpdate TerminatedActive8/31/2015 1:52 PM
DatesRegistration DateUpdate 3/4/2011 12:00:00 AM7/15/2015 12:00:00 AM8/31/2015 1:52 PM
DatesSigned By DateUpdate 2/10/2011 12:00:00 AM7/15/2015 12:00:00 AM8/31/2015 1:52 PM
DatesStart DateUpdate 4/1/2011 12:00:00 AM10/1/2015 12:00:00 AM8/31/2015 1:52 PM
TerminationsTermination CommentsUpdate Parkview Hospital filed their 2013 cost report on 6/2/2014 per CMS requirements. The DSH percentage on the most recently filed cost report does not meet program eligibility requirements. We notified the OPA by phone earlier today and are following up with a termination request. The pharmacy has been instructed not to purchase any medications on the 340B account. Thank you for your assistance. 8/31/2015 1:52 PM
TerminationsTermination DateUpdate 7/1/2014 12:00:00 AM 8/31/2015 1:52 PM
TerminationsTermination Effective DateUpdate 6/2/2014 12:00:00 AM 8/31/2015 1:52 PM
TerminationsTermination ReasonUpdate DSH percentage below statutory minimum 8/31/2015 1:52 PM
DetailsComments PublicInsert  8/31/15 Previously participated 4/1/11 through 7/1/14, terminated due to DSH percentage fell below statutory minimum, reinstated 10/1/15 with a DSH % of 12.17%8/31/2015 1:52 PM
DatesLast Date That 340B Drugs PurchasedUpdate  6/2/2014 12:00:00 AM7/2/2014 11:48 PM
DetailsStateUpdate ActiveTerminated7/2/2014 11:48 PM
TerminationsTermination CommentsUpdate  Parkview Hospital filed their 2013 cost report on 6/2/2014 per CMS requirements. The DSH percentage on the most recently filed cost report does not meet program eligibility requirements. We notified the OPA by phone earlier today and are following up with a termination request. The pharmacy has been instructed not to purchase any medications on the 340B account. Thank you for your assistance.7/2/2014 11:48 PM
TerminationsTermination DateUpdate  7/1/2014 12:00:00 AM7/2/2014 11:48 PM
TerminationsTermination Effective DateUpdate  6/2/2014 12:00:00 AM7/2/2014 11:48 PM
TerminationsTermination ReasonUpdate  DSH percentage below statutory minimum7/2/2014 11:48 PM
DetailsLast Recertification DateUpdate 7/1/2012 12:00:00 AM9/10/2013 12:00:00 AM9/10/2013 1:59 PM
DetailsLast Recertification DateUpdate  7/1/2012 12:00:00 AM5/15/2012 7:37 AM
DetailsEntity SubnameUpdate PARKVIEW NORTH 11/9/2011 10:54 AM
DetailsEntity SubnameUpdate  PARKVIEW NORTH9/29/2011 3:37 PM
ContactsPrimary ContactInsert  CMELIK, TIM CORPORATE DIRECTOR OF PHARMACY 26037334534/29/2011 2:51 PM
DetailsComments PublicInsert  04/29/11 REMOVED MEDICAID#(WAS100268480A)4/29/2011 2:49 PM
DetailsLast Recertification DateInsert   3/4/2011 12:07 PM
DetailsGrant NumberInsert   3/4/2011 12:07 PM
Details340B IDInsert  DSH1500213/4/2011 12:07 PM
DetailsIs Authorizing Official EHB DataInsert   3/4/2011 12:07 PM
DatesLast Date That 340B Drugs PurchasedInsert   3/4/2011 12:07 PM
DetailsMedicare Provider NumberInsert  1500213/4/2011 12:07 PM
DetailsEntity NameInsert  PARKVIEW HOSPITAL3/4/2011 12:07 PM
DetailsProgram CodeInsert  DSH3/4/2011 12:07 PM
DetailsEntity SubnameInsert   3/4/2011 12:07 PM
DatesParticipating Approval DateInsert  3/16/2011 12:00:00 AM3/4/2011 12:07 PM
DetailsStateInsert  Active3/4/2011 12:07 PM
DatesRegistration DateInsert  3/4/2011 12:00:00 AM3/4/2011 12:07 PM
DatesSigned By DateInsert  2/10/2011 12:00:00 AM3/4/2011 12:07 PM
DatesStart DateInsert  4/1/2011 12:00:00 AM3/4/2011 12:07 PM
TerminationsTermination CommentsInsert   3/4/2011 12:07 PM
TerminationsTermination DateInsert   3/4/2011 12:07 PM
TerminationsTermination Effective DateInsert   3/4/2011 12:07 PM
TerminationsTermination ReasonInsert   3/4/2011 12:07 PM
DetailsComments PublicInsert  9/28/11 ADDED SUB-DIV NAME; 04/29/11 REMOVED MEDICAID#(WAS100268480A)3/4/2011 12:07 PM