Covered Entity Details

DSH150015 FRANCISCAN HEALTH MICHIGAN CITY (Active) - information as of 4/29/2025 11:56:35 PM

Main Details

Name

FRANCISCAN HEALTH MICHIGAN CITY

Subdivision Name

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH150015

Medicare Provider Number

150015

Additional Details

Current Program Status

Active

Registration Date

7/11/2024

Participating Start Date

10/1/2024

Participating Approval Date

7/22/2024

Last Recertification Date

Contacts

Authorizing Official

Franciscan Alliance
Justin Kats, Division CFO - Crown Point & Michigan City
(219) 757-6403

Primary Contact

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

Addresses

Street Address

3500 FRANCISCAN WAY
MICHIGAN CITY, IN 46360

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
Participating Start 1/1/2019, Termination 7/1/2019, Reinstatement 10/1/2024	07/22/2024

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	100269360A	1710051941

Shipping Addresses

Shipping Address 1

Franciscan Health Michigan City
3500 Franciscan Way
Michigan City, IN 46360

Shipping Address 2

Franciscan Alliance, Inc. DBA Franciscan Outpatient Pharmacy Michigan City
3500 Franciscan Way
First Floor
Michigan City, IN 46360

Shipping Address 3

Franciscan Alliance, Inc. DBA Franciscan Home Infusion Pharmacy Munster
757 45th Ave
Suite 102
Munster, IN 46321

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	07/22/2024	10/01/2024		10/01/2024
Contract Detail	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	07/22/2024	10/01/2024		10/01/2024
Contract Detail	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	07/22/2024	10/01/2024		10/01/2024
Contract Detail	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	07/22/2024	10/01/2024		10/01/2024
Contract Detail	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	07/22/2024	10/01/2024		10/01/2024
Contract Detail	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	07/22/2024	10/01/2024		10/01/2024
Contract Detail	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	07/22/2024	10/01/2024		10/01/2024
Contract Detail	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	07/22/2024	10/01/2024		10/01/2024
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	07/22/2024	10/01/2024		10/01/2024
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	07/22/2024	10/01/2024		10/01/2024
Contract Detail	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	07/22/2024	10/01/2024		10/01/2024
Contract Detail	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	07/22/2024	10/01/2024		10/01/2024
Contract Detail	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	07/22/2024	10/01/2024		10/01/2024
Contract Detail	FRANCISCAN ALLIANCE INC	DBA FRANCISCAN OUTPATIENT PHARMACY - MIC	3500 FRANCISCAN WAY FL 1	MICHIGAN CITY	IN	46360	10/25/2018	01/01/2019	07/01/2019	07/01/2019
Contract Detail	FRANCISCAN ALLIANCE INC	DBA FRANCISCAN OUTPATIENT PHARMACY - MIC	3500 FRANCISCAN WAY FL 1	MICHIGAN CITY	IN	46360	07/22/2024	10/01/2024	12/15/2024	02/13/2025
Contract Detail	FRANCISCAN ALLIANCE, INC.	DBA FRANCISCAN HOME INFUSION PHARMACY MU	757 45TH AVE SUITE 102	MUNSTER	IN	46321	10/25/2018	01/01/2019	07/01/2019	07/01/2019
Contract Detail	FRANCISCAN ALLIANCE, INC.	DBA FRANCISCAN HOME INFUSION PHARMACY LA	1501 HARTFORD ST RM G540	LAFAYETTE	IN	47904	07/22/2024	10/01/2024		10/01/2024
Contract Detail	FRANCISCAN ALLIANCE, INC.	DBA FRANCISCAN HOME INFUSION PHARMACY MU	757 45TH AVE SUITE 102	MUNSTER	IN	46321	07/22/2024	10/01/2024	12/15/2024	02/13/2025
Contract Detail	FRANCISCAN HEALTH CROWN POINT	FRANCISCAN HEALTH CROWN POINT PHARMACY	12750 SAINT FRANCIS DR	CROWN POINT	IN	46307	07/22/2024	10/01/2024		10/01/2024
Contract Detail	FRANCISCAN HEALTH MUNSTER	701 SUPERIOR AVE		MUNSTER	IN	46321-4037	07/22/2024	10/01/2024		10/01/2024
Contract Detail	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 08512	1 MAIN STREET	PARK FOREST	IL	60466	07/22/2024	10/01/2024		10/01/2024
Contract Detail	HIGHLAND PARK CVS, L.L.C.	DBA CVS/PHARMACY# 10052	1515 SHERIDAN RD.	WILMETTE	IL	60091	07/22/2024	10/01/2024		10/01/2024
Contract Detail	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06481	901 N. KARWICK RD.	MICHIGAN CITY	IN	46360	07/22/2024	10/01/2024		10/01/2024
Contract Detail	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06911	3240 WILLOWCREEK RD.,	PORTAGE	IN	46368	07/22/2024	10/01/2024		10/01/2024
Contract Detail	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 02542	3405 RIDGE RD	HIGHLAND	IN	46322	07/22/2024	10/01/2024		10/01/2024
Contract Detail	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 02520	6445 CALUMET AVE.	HAMMOND	IN	46324	07/22/2024	10/01/2024		10/01/2024
Contract Detail	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06503	618 S. MAIN ST. PO BOX 241	NORTH WEBSTER	IN	46555	07/22/2024	10/01/2024		10/01/2024
Contract Detail	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06486	8989 E US HWY 20	NEW CARLISLE	IN	46552	07/22/2024	10/01/2024		10/01/2024
Contract Detail	HOOK-SUPERX, L.L.C.	DBA CVS/PHARMACY #0434	8100 EAST RIDGE ROAD	HOBART	IN	46342	07/22/2024	10/01/2024		10/01/2024
Contract Detail	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 02519	2338 US HIGHWAY 41	SCHERERVILLE	IN	46375	07/22/2024	10/01/2024		10/01/2024
Contract Detail	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06915	150 MORTHLAND DRIVE	VALPARAISO	IN	46383	07/22/2024	10/01/2024		10/01/2024
Contract Detail	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 08518	3835 45TH STREET	HIGHLAND	IN	46322	07/22/2024	10/01/2024		10/01/2024
Contract Detail	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 02665	2272 NORTH MAIN ST.	CROWNPOINT	IN	46307	07/22/2024	10/01/2024		10/01/2024
Contract Detail	HOOK-SUPERX, L.L.C.	CVS PHARMACY # 17139	9885 WICKER AVE	ST JOHN	IN	46373	07/22/2024	10/01/2024		10/01/2024
Contract Detail	HOOK-SUPERX, L.L.C.	CVS/PHARMACY # 10176	10 EAST 81ST AVENUE	MERRILLVILLE	IN	46410	07/22/2024	10/01/2024		10/01/2024
Contract Detail	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06908	310 N. HALLECK ST.	DEMOTTE	IN	46310	07/22/2024	10/01/2024		10/01/2024
Contract Detail	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06912	11115 WEST 133RD STREET	CEDAR LAKE	IN	46303	07/22/2024	10/01/2024		10/01/2024
Contract Detail	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06483	1407 LINCOLNWAY	LAPORTE	IN	46350	07/22/2024	10/01/2024		10/01/2024
Contract Detail	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 04368	801 MAIN ST.	MUNSTER	IN	46321	07/22/2024	10/01/2024		10/01/2024
Contract Detail	HOOK-SUPERX, L.L.C.	CVS PHARMACY # 16630	2420 LAPORTE AVE	VALPARAISO	IN	46383	07/22/2024	10/01/2024		10/01/2024
Contract Detail	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06910	505 EAST 1100 NORTH	CHESTERTON	IN	46304	07/22/2024	10/01/2024		10/01/2024
Contract Detail	HOOK-SUPERX, L.L.C.	DBA CVS/PHARMACY #10824	10809 RANDOLPH ST	CROWN POINT	IN	46307	07/22/2024	10/01/2024		10/01/2024
Contract Detail	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06484	3253 FRANKLIN ST.	MICHIGAN CITY	IN	46360	07/22/2024	10/01/2024		10/01/2024
Contract Detail	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06917	5301 BROADWAY	MERRILLVILLE	IN	46410	07/22/2024	10/01/2024		10/01/2024
Contract Detail	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 03398	100 EAST STATE RD 231	CROWN POINT	IN	46307	07/22/2024	10/01/2024		10/01/2024
Contract Detail	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06905	1805 CALUMET AVE.	VALPARAISO	IN	46383	07/22/2024	10/01/2024		10/01/2024
Contract Detail	HOOK-SUPERX, L.L.C.	DBA CVS/PHARMACY # 10259	225 JOLIET STREET	DYER	IN	46311	07/22/2024	10/01/2024		10/01/2024
Contract Detail	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06460	3600 CASSOPOLIS ST.	ELKHART	IN	46514	07/22/2024	10/01/2024		10/01/2024
Contract Detail	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06543	607 E. TALMER AVE.	NORTH JUDSON	IN	46366	07/22/2024	10/01/2024		10/01/2024
Contract Detail	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06485	300 LIBERTY ST.	WALKERTON	IN	46574	07/22/2024	10/01/2024		10/01/2024
Contract Detail	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06538	907 S. HEATON	KNOX	IN	46534	07/22/2024	10/01/2024		10/01/2024
Contract Detail	ONCOMED THE ONCOLOGY PHARMACY OF BUFFALO	D/B/A ONCO360	140 JOHN JAMES AUDUBON PKWY STE 101	AMHERST	NY	14228	10/25/2018	01/01/2019	07/01/2019	07/01/2019
Contract Detail	ONCOMED THE ONCOLOGY PHARMACY OF BUFFALO	D/B/A ONCO360	140 JOHN JAMES AUDUBON PKWY STE 101	AMHERST	NY	14228	07/22/2024	10/01/2024		10/01/2024
Contract Detail	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	07/22/2024	10/01/2024		10/01/2024
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	07/22/2024	10/01/2024		10/01/2024
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	07/22/2024	10/01/2024		10/01/2024
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	07/22/2024	10/01/2024		10/01/2024
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #11338	10160 INTERNATIONAL BLVD.	WEST CHESTER	OH	45246	07/22/2024	10/01/2024		10/01/2024
Contract Detail	SINA DRUG LLC	D/B/A ONCO 360	13410 EASTPOINT CENTRE DR STE 101	LOUISVILLE	KY	40223	10/25/2018	01/01/2019	07/01/2019	07/01/2019
Contract Detail	SINA DRUG LLC	D/B/A ONCO 360	13410 EASTPOINT CENTRE DR STE 101	LOUISVILLE	KY	40223	07/22/2024	10/01/2024		10/01/2024
Contract Detail	SORKIN'S RX LTD	D/B/A CAREMED PHARMACEUTICAL SERVICES	1985 MARCUS AVE STE 130	NEW HYDE PARK	NY	11042-2024	10/25/2018	01/01/2019	07/01/2019	07/01/2019
Contract Detail	SORKIN'S RX LTD	D/B/A CAREMED PHARMACEUTICAL SERVICES	1985 MARCUS AVE STE 130	NEW HYDE PARK	NY	11042-2024	07/22/2024	10/01/2024		10/01/2024
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05141	1302 W SR 2	LAPORTE	IN	46350	10/25/2018	01/01/2019	07/01/2019	07/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04946	580 INDIAN BOUNDARY RD	CHESTERTON	IN	46304	10/25/2018	01/01/2019	07/01/2019	07/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS #12812	1520 S. COURT STREET	CROWN POINT	IN	46307	10/25/2018	01/01/2019	07/01/2019	07/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03680	1903 CALUMET AVE.	VALPARAISO	IN	46383	10/25/2018	01/01/2019	07/01/2019	07/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04750	400 W LINCOLN HWY	MERRILLVILLE	IN	46410	10/25/2018	01/01/2019	07/01/2019	07/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS #11084	1816 FRANKLIN ST	MICHIGAN CITY	IN	46360	10/25/2018	01/01/2019	07/01/2019	07/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS #13949	6001 CENTRAL AVE	PORTAGE	IN	46368-3506	10/25/2018	01/01/2019	07/01/2019	07/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 10123	10795 BROADWAY	CROWN POINT	IN	46307-8834	10/25/2018	01/01/2019	07/01/2019	07/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05727	13242 WICKER AVENUE	CEDAR LAKE	IN	46303	10/25/2018	01/01/2019	07/01/2019	07/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04486	5520 US HWY 30	SCHERERVILLE	IN	46375	10/25/2018	01/01/2019	07/01/2019	07/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05241	252 MORTHLAND DRIVE	VALPARAISO	IN	46383	10/25/2018	01/01/2019	07/01/2019	07/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04560	5995 US HWY. 6	PORTAGE	IN	46368	10/25/2018	01/01/2019	07/01/2019	07/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 09318	525 E LINCOLNWAY	LAPORTE	IN	46350-3833	10/25/2018	01/01/2019	07/01/2019	07/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04635	101 W HWY 20	MICHIGAN CITY	IN	46360	10/25/2018	01/01/2019	07/01/2019	07/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04829	10920 RANDOLPH ST.	CROWN POINT	IN	46307	10/25/2018	01/01/2019	07/01/2019	07/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06216	732 W OLD RIDGE RD	HOBART	IN	46342	10/25/2018	01/01/2019	07/01/2019	07/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 12074	308 NORTH MAIN STREET	HEBRON	IN	46341	10/25/2018	01/01/2019	07/01/2019	07/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05194	1704 EAST COMMERCIAL AVENUE	LOWELL	IN	46356	10/25/2018	01/01/2019	07/01/2019	07/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06906	6097 BROADWAY	MERRILLVILLE	IN	46410	10/25/2018	01/01/2019	07/01/2019	07/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04668	1003 N MAIN STREET	CROWN POINT	IN	46307	10/25/2018	01/01/2019	07/01/2019	07/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04486	5520 US HWY 30	SCHERERVILLE	IN	46375	07/22/2024	10/01/2024		10/01/2024
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04560	5995 US HWY. 6	PORTAGE	IN	46368	07/22/2024	10/01/2024		10/01/2024
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04668	1003 N MAIN STREET	CROWN POINT	IN	46307	07/22/2024	10/01/2024		10/01/2024
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06906	6097 BROADWAY	MERRILLVILLE	IN	46410	07/22/2024	10/01/2024		10/01/2024
Contract Detail	WALGREEN CO.	DBA: WALGREENS #13949	6001 CENTRAL AVE	PORTAGE	IN	46368-3506	07/22/2024	10/01/2024		10/01/2024
Contract Detail	WALGREEN CO.	DBA: WALGREENS #11084	1816 FRANKLIN ST	MICHIGAN CITY	IN	46360	07/22/2024	10/01/2024		10/01/2024
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05141	1302 W SR 2	LAPORTE	IN	46350	07/22/2024	10/01/2024		10/01/2024
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04635	101 W HWY 20	MICHIGAN CITY	IN	46360	07/22/2024	10/01/2024		10/01/2024
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05194	1704 EAST COMMERCIAL AVENUE	LOWELL	IN	46356	07/22/2024	10/01/2024		10/01/2024
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06216	732 W OLD RIDGE RD	HOBART	IN	46342	07/22/2024	10/01/2024		10/01/2024
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 09318	525 E LINCOLNWAY	LAPORTE	IN	46350-3833	07/22/2024	10/01/2024		10/01/2024
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03680	1903 CALUMET AVE.	VALPARAISO	IN	46383	07/22/2024	10/01/2024		10/01/2024
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05241	252 MORTHLAND DRIVE	VALPARAISO	IN	46383	07/22/2024	10/01/2024		10/01/2024
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04750	400 W LINCOLN HWY	MERRILLVILLE	IN	46410	07/22/2024	10/01/2024		10/01/2024
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04946	580 INDIAN BOUNDARY RD	CHESTERTON	IN	46304	07/22/2024	10/01/2024		10/01/2024
Contract Detail	WALGREEN CO.	DBA: WALGREENS #12812	1520 S. COURT STREET	CROWN POINT	IN	46307	07/22/2024	10/01/2024		10/01/2024
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05727	13242 WICKER AVENUE	CEDAR LAKE	IN	46303	07/22/2024	10/01/2024		10/01/2024
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04829	10920 RANDOLPH ST.	CROWN POINT	IN	46307	07/22/2024	10/01/2024		10/01/2024
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 10123	10795 BROADWAY	CROWN POINT	IN	46307-8834	07/22/2024	10/01/2024		10/01/2024
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 12074	308 NORTH MAIN STREET	HEBRON	IN	46341	07/22/2024	10/01/2024		10/01/2024
Contract Detail	Walgreens Central Fill #21399	4132Plainfield Rd	Ste 110	Indianapolis	IN	46231-7021	07/22/2024	10/01/2024		10/01/2024

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH150015A	Child	DSH	FRANCISCAN HEALTH MICHIGAN CITY	FRANCISCAN HEALTH MICHIGAN CITY - Woodland Cancer Care Center	8955 W 400 N	MICHIGAN CITY	IN	Active
DSH150015B	Child	DSH	FRANCISCAN HEALTH MICHIGAN CITY	Chesterton Health & Emergency Center (Free Standing Emergency Dept.) - Emergency Department	770 Indian Boundary Road	Chesterton	IN	Active
DSH150015C	Child	DSH	FRANCISCAN HEALTH MICHIGAN CITY	FRANCISCAN HEALTH CHESTERTON - INFU - Infusion OP Services / Chesterton Infusion Center	770 INDIAN BOUNDARY RD	CHESTERTON	IN	Active
DSH150015D	Child	DSH	FRANCISCAN HEALTH MICHIGAN CITY	FRANCISCAN HEALTH MICHIGAN CITY - Woodland Surgery Center	8865 W 400 N STE 100	MICHIGAN CITY	IN	Active
DSH150015E	Child	DSH	FRANCISCAN HEALTH MICHIGAN CITY	FRANCISCAN HEALTH MICHIGAN CITY INF - Infusion Center at Munster	701 SUPERIOR AVENUE, SUITE 200	MUNSTER	IN	Active
DSH150015F	Child	DSH	FRANCISCAN HEALTH MICHIGAN CITY	FRANCISCAN HEALTH MICHIGAN CITY INF - Infusion Center at Crown Point, Ground Floor	1201 S. Main Street	Crown Point	IN	Active
DSH150015G	Child	DSH	FRANCISCAN HEALTH MICHIGAN CITY	FRANCISCAN HEALTH MICHIGAN CITY INF - Infusion Center at Calumet	761 45TH AVE., SUITE 101/102	MUNSTER	IN	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Addresses	Shipping Address	Update	Change Request	Franciscan Alliance, Inc. DBA Franciscan Home Infusion Pharmacy Munster 757 45th Ave Munster, IN 46321	Franciscan Alliance, Inc. DBA Franciscan Home Infusion Pharmacy Munster 757 45th Ave Suite 102 Munster, IN 46321	12/4/2024 6:44 AM
Addresses	Shipping Address	Insert	Change Request		Franciscan Health Michigan City 3500 Franciscan Way Michigan City, IN 46360	11/25/2024 9:43 AM
Addresses	Shipping Address	Insert	Change Request		Franciscan Alliance, Inc. DBA Franciscan Outpatient Pharmacy Michigan City 3500 Franciscan Way First Floor Michigan City, IN 46360	11/25/2024 9:43 AM
Addresses	Shipping Address	Insert	Change Request		Franciscan Alliance, Inc. DBA Franciscan Home Infusion Pharmacy Munster 757 45th Ave Munster, IN 46321	11/25/2024 9:43 AM
Details	State	Update		Approved	Active	10/1/2024 12:01 AM
Addresses	Shipping Address	Delete	Hospital Type Change Request	Franciscan Health Michigan City 301 W. Homer St. Michigan City, IN 46360		7/22/2024 1:09 PM
Medicaid Billing	NPI: Number	Delete	Hospital Type Change Request	1710051941 ( )		7/22/2024 1:09 PM
Medicaid Billing	NPI: Number	Insert	Hospital Type Change Request		1710051941	7/22/2024 1:09 PM
Medicaid Billing	NPI: State	Insert	Hospital Type Change Request		IN	7/22/2024 1:09 PM
Contacts	Primary Contact	Update	Hospital Type Change Request	Harber, Eugene Corporate Pharmacy Manager, 340b Operations Franciscan Alliance 2199322300-35561	Shondell, Laura Administrative Director Medication Systems and Operations Franciscan Health 7654236900	7/22/2024 1:09 PM
Contacts	Authorizing Official	Update	Hospital Type Change Request	Weber, Trish L. VP Operations/CNO Franciscan Health Michigan City 2198771766	Kats, Justin Division CFO - Crown Point & Michigan City Franciscan Alliance 2197576403	7/22/2024 1:09 PM
Contacts	Signed By	Update	Hospital Type Change Request	Weber, Trish L. VP Operations/CNO Franciscan Health Michigan City 2198771766	Kats, Justin Division CFO - Crown Point & Michigan City Franciscan Alliance 2197576403	7/22/2024 1:09 PM
Dates	Last Date That 340B Drugs Purchased	Update	Hospital Type Change Request	5/30/2019 12:00:00 AM		7/22/2024 1:09 PM
Dates	Participating Approval Date	Update	Hospital Type Change Request	10/25/2018 5:35:05 PM	7/22/2024 1:09:48 PM	7/22/2024 1:09 PM
Details	State	Update	Hospital Type Change Request	Terminated	Approved	7/22/2024 1:09 PM
Dates	Registration Date	Update	Hospital Type Change Request	10/11/2018 1:45:02 PM	7/11/2024 6:52:05 AM	7/22/2024 1:09 PM
Dates	Signed By Date	Update	Hospital Type Change Request	10/12/2018 3:28:41 PM	7/19/2024 11:02:49 AM	7/22/2024 1:09 PM
Dates	Start Date	Update	Hospital Type Change Request	1/1/2019 12:00:00 AM	10/1/2024 12:00:00 AM	7/22/2024 1:09 PM
Terminations	Termination Date	Update	Hospital Type Change Request	7/1/2019 12:00:00 AM		7/22/2024 1:09 PM
Terminations	Termination Effective Date	Update	Hospital Type Change Request	5/31/2019 12:00:00 AM		7/22/2024 1:09 PM
Terminations	Termination Reason	Update	Hospital Type Change Request	DSH percentage below statutory minimum		7/22/2024 1:09 PM
Details	Comments Public	Insert	Hospital Type Change Request		Participating Start 1/1/2019, Termination 7/1/2019, Reinstatement 10/1/2024	7/22/2024 10:40 AM
Details	State	Update		To Be Terminated	Terminated	7/1/2019 12:05 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		5/30/2019 12:00:00 AM	6/3/2019 3:15 PM
Details	State	Update	Termination Request	Active	To Be Terminated	6/3/2019 3:15 PM
Terminations	Termination Date	Update	Termination Request		7/1/2019 12:00:00 AM	6/3/2019 3:15 PM
Terminations	Termination Effective Date	Update	Termination Request		5/31/2019 12:00:00 AM	6/3/2019 3:15 PM
Terminations	Termination Reason	Update	Termination Request		DSH percentage below statutory minimum	6/3/2019 3:15 PM
Addresses	Shipping Address	Insert	Change Request		Franciscan Health Michigan City 301 W. Homer St. Michigan City, IN 46360	2/22/2019 6:10 AM
Addresses	Main Address	Update	Change Request	301 W. HOMER STREET MICHIGAN CITY, IN 46360	3500 Franciscan Way MICHIGAN CITY, IN 46360	1/8/2019 1:08 PM
Details	State	Update		Approved	Active	1/1/2019 12:05 AM
Contacts	Signed By	Insert	Hospital Type Change Request		Weber, Trish L. VP Operations/CNO Franciscan Health Michigan City 2198771766	10/25/2018 5:35 PM
Details	340B ID	Update	Hospital Type Change Request		DSH150015	10/25/2018 5:35 PM
Dates	Participating Approval Date	Update	Hospital Type Change Request		10/25/2018 5:35:05 PM	10/25/2018 5:35 PM
Details	State	Update	Hospital Type Change Request	Pending	Approved	10/25/2018 5:35 PM
Dates	Signed By Date	Update	Hospital Type Change Request		10/12/2018 3:28:41 PM	10/25/2018 5:35 PM
Dates	Start Date	Update	Hospital Type Change Request		1/1/2019 12:00:00 AM	10/25/2018 5:35 PM
Addresses	Main Address	Insert	Hospital Type Change Request		301 W. HOMER STREET MICHIGAN CITY, IN 46360	10/11/2018 1:45 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Hospital Type Change Request		False	10/11/2018 1:45 PM
Medicaid Billing	Medicaid: Number	Insert	Hospital Type Change Request		100269360A	10/11/2018 1:45 PM
Medicaid Billing	Medicaid: State	Insert	Hospital Type Change Request		IN	10/11/2018 1:45 PM
Medicaid Billing	NPI: Number	Insert	Hospital Type Change Request		1710051941	10/11/2018 1:45 PM
Contacts	Authorizing Official	Insert	Hospital Type Change Request		Weber, Trish L. VP Operations/CNO Franciscan Health Michigan City 2198771766	10/11/2018 1:45 PM
Contacts	Primary Contact	Insert	Hospital Type Change Request		Harber, Eugene Corporate Pharmacy Manager, 340b Operations Franciscan Alliance 2199322300-35561	10/11/2018 1:45 PM
Details	Last Recertification Date	Insert	Hospital Type Change Request			10/11/2018 1:45 PM
Details	Grant Number	Insert	Hospital Type Change Request			10/11/2018 1:45 PM
Details	340B ID	Insert	Hospital Type Change Request			10/11/2018 1:45 PM
Details	Is Authorizing Official EHB Data	Insert	Hospital Type Change Request			10/11/2018 1:45 PM
Dates	Last Date That 340B Drugs Purchased	Insert	Hospital Type Change Request			10/11/2018 1:45 PM
Details	Medicare Provider Number	Insert	Hospital Type Change Request		150015	10/11/2018 1:45 PM
Details	Entity Name	Insert	Hospital Type Change Request		FRANCISCAN HEALTH MICHIGAN CITY	10/11/2018 1:45 PM
Details	Program Code	Insert	Hospital Type Change Request		DSH	10/11/2018 1:45 PM
Details	Entity Subname	Insert	Hospital Type Change Request			10/11/2018 1:45 PM
Dates	Participating Approval Date	Insert	Hospital Type Change Request			10/11/2018 1:45 PM
Details	State	Insert	Hospital Type Change Request		Pending	10/11/2018 1:45 PM
Dates	Registration Date	Insert	Hospital Type Change Request		10/11/2018 1:45:02 PM	10/11/2018 1:45 PM
Dates	Signed By Date	Insert	Hospital Type Change Request			10/11/2018 1:45 PM
Dates	Start Date	Insert	Hospital Type Change Request			10/11/2018 1:45 PM
Terminations	Termination Comments	Insert	Hospital Type Change Request			10/11/2018 1:45 PM
Terminations	Termination Date	Insert	Hospital Type Change Request			10/11/2018 1:45 PM
Terminations	Termination Effective Date	Insert	Hospital Type Change Request			10/11/2018 1:45 PM
Terminations	Termination Reason	Insert	Hospital Type Change Request			10/11/2018 1:45 PM