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Parkview Wabash Hospital,Inc Pharmacy
710 North East Street
Wabash, IN 46992
| CAH151310-01 | Child | CAH | Parkview Wabash Hospital, Inc | PWB REHAB ST OP | 502 S Cass Street | Wabash | IN | Terminated |
| CAH151310-02 | Child | CAH | Parkview Wabash Hospital, Inc | PWB Pulmonary/Cardiac Rehab | 8 John Kissinger Drive | Wabash | IN | Active |
| CAH151310-03 | Child | CAH | Parkview Wabash Hospital, Inc | PWAB OP Senior Group Therapy | 8 John Kissinger Drive | Wabash | IN | Active |
| CAH151310-04 | Child | CAH | Parkview Wabash Hospital, Inc | PWB OP Infusion | 8 John Kissinger Drive | Wabash | IN | Active |
| CAH151310-05 | Child | CAH | Parkview Wabash Hospital, Inc | PWB Sleep Disorders Lab | 8 John Kissinger Drive | Wabash | IN | Active |
| Contacts | Signed By | Update | Change Request | Risser, Stanton
VP Finance
2603738403 | Risser, Stanton
Assoc Chief Financial Officer
Parkview Health System
2602669313 | 7/29/2024 8:23 AM |
| Details | State | Update | | To Be Terminated | Terminated | 1/1/2021 12:01 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | Termination Request | | 11/12/2020 12:00:00 AM | 11/16/2020 11:14 AM |
| Details | State | Update | Termination Request | Active | To Be Terminated | 11/16/2020 11:14 AM |
| Terminations | Termination Comments | Update | Termination Request | | This location has closed | 11/16/2020 11:14 AM |
| Terminations | Termination Date | Update | Termination Request | | 1/1/2021 12:00:00 AM | 11/16/2020 11:14 AM |
| Terminations | Termination Effective Date | Update | Termination Request | | 11/13/2020 12:00:00 AM | 11/16/2020 11:14 AM |
| Terminations | Termination Reason | Update | Termination Request | | Site closure | 11/16/2020 11:14 AM |
| Details | Last Recertification Date | Update | Recertification | 8/26/2019 6:56:00 AM | 8/20/2020 6:15:20 PM | 8/20/2020 6:15 PM |
| Details | Last Recertification Date | Update | Recertification | 8/15/2018 3:56:58 PM | 8/26/2019 6:56:00 AM | 8/26/2019 6:56 AM |
| Details | Entity Subname | Update | Recertification | The Rehab Place / PWB REHAB ST OP | PWB REHAB ST OP | 8/26/2019 6:56 AM |
| Contacts | Primary Contact | Update | Profile Change Request | Dickmeyer, Stephanie
340B Program Coordinator
Parkview Health
2602664408 | Dickmeyer, Stephanie
340B Program Supervisor
Parkview Health
2602664408 | 1/28/2019 7:57 AM |
| Details | Last Recertification Date | Update | Recertification | 11/15/2017 8:05:14 AM | 8/15/2018 3:56:58 PM | 8/15/2018 3:56 PM |
| Details | Last Recertification Date | Update | Recertification | 8/15/2016 12:00:00 AM | 11/15/2017 8:05:14 AM | 11/15/2017 8:05 AM |
| Details | Entity Name | Update | Recertification | WABASH COUNTY HOSPITAL | Parkview Wabash Hospital, Inc | 10/26/2017 10:22 AM |
| Contacts | Authorizing Official | Update | | Wickens, Jeanne
CFO
2603738407 | Wickens, Jeanne
CFO
Parkview Health
2603738407 | 10/10/2017 9:37 AM |
| Contacts | Primary Contact | Update | | Dickmeyer, Stephanie
340B Program Coordinator
2602664408 | Dickmeyer, Stephanie
340B Program Coordinator
Parkview Health
2602664408 | 10/4/2017 11:10 AM |
| Contacts | Authorizing Official | Insert | | | Wickens, Jeanne
CFO
2603738407 | 8/9/2017 12:48 PM |
| Contacts | Primary Contact | Insert | | | Dickmeyer, Stephanie
340B Program Coordinator
2602664408 | 5/31/2017 2:55 PM |
| Contacts | Signed By | Insert | | | Risser, Stanton
VP Finance
2603738403 | 5/23/2017 11:49 AM |
| Addresses | Shipping Address | Delete | | Parkview Distribution Center
1450 Production Road
Fort Wayne, IN 46808 | | 5/23/2017 11:48 AM |
| Addresses | Main Address | Insert | | |
502 S Cass Street
Wabash, IN 46992-1916 | 5/23/2017 11:48 AM |
| Addresses | Billing Address | Insert | | | Parkview Memorial Hospital, INC
2200 Randallia Dr
Fort Wayne, IN 46805 | 5/23/2017 11:48 AM |
| Addresses | Shipping Address | Insert | | | Parkview Wabash Hospital,Inc Pharmacy
710 North East Street
Wabash, IN 46992 | 5/23/2017 11:48 AM |
| Addresses | Shipping Address | Insert | | | Parkview Distribution Center
1450 Production Road
Fort Wayne, IN 46808 | 5/23/2017 11:48 AM |
| Details | Last Recertification Date | Update | | | 8/15/2016 12:00:00 AM | 8/15/2016 10:31 AM |
| Dates | Participating Approval Date | Update | | | 10/22/2015 12:00:00 AM | 10/22/2015 4:53 PM |
| Details | State | Update | | Pending | Active | 10/22/2015 4:53 PM |
| Dates | Start Date | Update | | | 1/1/2016 12:00:00 AM | 10/22/2015 4:53 PM |
| Details | 340B ID | Update | | OUTPATIENT_ONLINE_REG_54677 | CAH151310-01 | 10/9/2015 12:01 PM |
| Details | 340B ID | Update | | | OUTPATIENT_ONLINE_REG_54677 | 10/7/2015 1:39 PM |
| Details | Last Recertification Date | Insert | | | | 10/7/2015 1:39 PM |
| Details | Grant Number | Insert | | | | 10/7/2015 1:39 PM |
| Details | 340B ID | Insert | | | | 10/7/2015 1:39 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 10/7/2015 1:39 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 10/7/2015 1:39 PM |
| Details | Medicare Provider Number | Insert | | | 151310 | 10/7/2015 1:39 PM |
| Details | Entity Name | Insert | | | WABASH COUNTY HOSPITAL | 10/7/2015 1:39 PM |
| Details | Program Code | Insert | | | CAH | 10/7/2015 1:39 PM |
| Details | Entity Subname | Insert | | | The Rehab Place / PWB REHAB ST OP | 10/7/2015 1:39 PM |
| Dates | Participating Approval Date | Insert | | | | 10/7/2015 1:39 PM |
| Details | State | Insert | | | Pending | 10/7/2015 1:39 PM |
| Dates | Registration Date | Insert | | | 10/7/2015 12:00:00 AM | 10/7/2015 1:39 PM |
| Dates | Signed By Date | Insert | | | 10/7/2015 12:00:00 AM | 10/7/2015 1:39 PM |
| Dates | Start Date | Insert | | | | 10/7/2015 1:39 PM |
| Terminations | Termination Comments | Insert | | | | 10/7/2015 1:39 PM |
| Terminations | Termination Date | Insert | | | | 10/7/2015 1:39 PM |
| Terminations | Termination Effective Date | Insert | | | | 10/7/2015 1:39 PM |
| Terminations | Termination Reason | Insert | | | | 10/7/2015 1:39 PM |