Covered Entity Details

DSH150015B FRANCISCAN HEALTH MICHIGAN CITY (Active) - information as of 5/29/2025 1:46:55 AM

Main Details

Name

FRANCISCAN HEALTH MICHIGAN CITY

Subdivision Name

Chesterton Health & Emergency Center (Free Standing Emergency Dept.) - Emergency Department

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH150015B

Medicare Provider Number

150015

Outpatient Facility Provider Number

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

770 Indian Boundary Road
Chesterton, IN 46304

Billing Address

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

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
Participating Start Date1/1/2019, Termination 7/1/2019, Reinstatement 10/1/2024	07/18/2024

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 Health Michigan City Chesterton Health & Emergency Center
770 Indian Boundary Rd
Chesterton, IN 46304

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

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
Details	State	Update		Approved	Active	10/1/2024 12:01 AM
Addresses	Billing Address	Insert	Reinstatement		Franciscan Health Michigan City 3500 Franciscan Way Michigan City, IN 46360	7/22/2024 1:10 PM
Addresses	Shipping Address	Insert	Reinstatement		Franciscan Health Michigan City 3500 Franciscan Way Michigan City, IN 46360	7/22/2024 1:10 PM
Addresses	Shipping Address	Insert	Reinstatement		Franciscan Health Michigan City Chesterton Health & Emergency Center 770 Indian Boundary Rd Chesterton, IN 46304	7/22/2024 1:10 PM
Medicaid Billing	NPI: Number	Delete	Reinstatement	1710051941 ( )		7/22/2024 1:10 PM
Medicaid Billing	NPI: Number	Insert	Reinstatement		1710051941	7/22/2024 1:10 PM
Medicaid Billing	NPI: State	Insert	Reinstatement		IN	7/22/2024 1:10 PM
Contacts	Primary Contact	Update	Reinstatement	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 1:10 PM
Contacts	Authorizing Official	Update	Reinstatement	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 1:10 PM
Contacts	Signed By	Update	Reinstatement	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 1:10 PM
Dates	Last Date That 340B Drugs Purchased	Update	Reinstatement	5/30/2019 12:00:00 AM		7/22/2024 1:10 PM
Dates	Participating Approval Date	Update	Reinstatement	10/19/2018 2:45:16 PM	7/22/2024 1:10:56 PM	7/22/2024 1:10 PM
Details	State	Update	Reinstatement	Terminated	Approved	7/22/2024 1:10 PM
Dates	Registration Date	Update	Reinstatement	10/12/2018 11:52:53 AM	7/11/2024 7:48:30 AM	7/22/2024 1:10 PM
Dates	Signed By Date	Update	Reinstatement	10/12/2018 3:29:00 PM	7/11/2024 1:19:00 PM	7/22/2024 1:10 PM
Dates	Start Date	Update	Reinstatement	1/1/2019 12:00:00 AM	10/1/2024 12:00:00 AM	7/22/2024 1:10 PM
Terminations	Termination Date	Update	Reinstatement	7/1/2019 12:00:00 AM		7/22/2024 1:10 PM
Terminations	Termination Effective Date	Update	Reinstatement	5/31/2019 12:00:00 AM		7/22/2024 1:10 PM
Terminations	Termination Reason	Update	Reinstatement	DSH percentage below statutory minimum		7/22/2024 1:10 PM
Details	Comments Public	Insert	Reinstatement		Participating Start Date1/1/2019, Termination 7/1/2019, Reinstatement 10/1/2024	7/18/2024 12:29 PM
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
Details	State	Update		Approved	Active	1/1/2019 12:05 AM
Contacts	Signed By	Insert	New Registration		Weber, Trish L. VP Operations/CNO Franciscan Health Michigan City 2198771766	10/19/2018 2:45 PM
Details	340B ID	Update	New Registration		DSH150015B	10/19/2018 2:45 PM
Details	Entity Subname	Update	New Registration	Chesterton Health & Emergency Center (Free Standing Emergency Dept.)	Chesterton Health & Emergency Center (Free Standing Emergency Dept.) - Emergency Department	10/19/2018 2:45 PM
Dates	Participating Approval Date	Update	New Registration		10/19/2018 2:45:16 PM	10/19/2018 2:45 PM
Details	State	Update	New Registration	Pending	Approved	10/19/2018 2:45 PM
Dates	Signed By Date	Update	New Registration		10/12/2018 3:29:00 PM	10/19/2018 2:45 PM
Dates	Start Date	Update	New Registration		1/1/2019 12:00:00 AM	10/19/2018 2:45 PM
Addresses	Main Address	Insert	New Registration		770 Indian Boundary Road Chesterton, IN 46304	10/12/2018 11:52 AM
Addresses	Billing Address	Insert	New Registration		Franciscan Health Michigan City 301 W HOMER ST Michigan City, IN 46360	10/12/2018 11:52 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/12/2018 11:52 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		100269360A	10/12/2018 11:52 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		IN	10/12/2018 11:52 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1710051941	10/12/2018 11:52 AM
Contacts	Authorizing Official	Insert	New Registration		Weber, Trish L. VP Operations/CNO Franciscan Health Michigan City 2198771766	10/12/2018 11:52 AM
Contacts	Primary Contact	Insert	New Registration		Harber, Eugene Corporate Pharmacy Manager, 340b Operations Franciscan Alliance 2199322300-35561	10/12/2018 11:52 AM
Details	Last Recertification Date	Insert	New Registration			10/12/2018 11:52 AM
Details	Grant Number	Insert	New Registration			10/12/2018 11:52 AM
Details	340B ID	Insert	New Registration			10/12/2018 11:52 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/12/2018 11:52 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/12/2018 11:52 AM
Details	Medicare Provider Number	Insert	New Registration		150015	10/12/2018 11:52 AM
Details	Entity Name	Insert	New Registration		FRANCISCAN HEALTH MICHIGAN CITY	10/12/2018 11:52 AM
Details	Program Code	Insert	New Registration		DSH	10/12/2018 11:52 AM
Details	Entity Subname	Insert	New Registration		Chesterton Health & Emergency Center (Free Standing Emergency Dept.)	10/12/2018 11:52 AM
Dates	Participating Approval Date	Insert	New Registration			10/12/2018 11:52 AM
Details	State	Insert	New Registration		Pending	10/12/2018 11:52 AM
Dates	Registration Date	Insert	New Registration		10/12/2018 11:52:53 AM	10/12/2018 11:52 AM
Dates	Signed By Date	Insert	New Registration			10/12/2018 11:52 AM
Dates	Start Date	Insert	New Registration			10/12/2018 11:52 AM
Terminations	Termination Comments	Insert	New Registration			10/12/2018 11:52 AM
Terminations	Termination Date	Insert	New Registration			10/12/2018 11:52 AM
Terminations	Termination Effective Date	Insert	New Registration			10/12/2018 11:52 AM
Terminations	Termination Reason	Insert	New Registration			10/12/2018 11:52 AM