Covered Entity Details

RRC150015-05 FRANCISCAN HEALTH MICHIGAN CITY (Terminated) - information as of 4/29/2025 1:41:29 AM

Main Details

Name

FRANCISCAN HEALTH MICHIGAN CITY

Subdivision Name

FRANCISCAN HEALTH MICHIGAN CITY INF - Infusion Center at Munster

Type

Rural Referral Center

Rural

Yes

340B ID

RRC150015-05

Medicare Provider Number

150015

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

5/3/2023

Participating Start Date

7/1/2023

Participating Approval Date

6/7/2023

Last Recertification Date

9/11/2023

Termination Date
Termination Reason

10/1/2024
Change of covered entity type

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

701 SUPERIOR AVENUE, SUITE 200
MUNSTER, IN 46321-4037

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
No records to display.

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 Munster Infusion Satellite Pharmacy
701 Superior Ave
Munster, IN 46321

Shipping Address 2

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

Shipping Address 3

Franciscan Home Infusion Pharmacy Munster
757 45th Street Suite 102
Munster, IN 46321

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
RRC150015-01	Child	RRC	FRANCISCAN HEALTH MICHIGAN CITY	Woodland Surgery Center	8865 W. 400 N., Suite 100	Michigan City	IN	Terminated
RRC150015-02	Child	RRC	FRANCISCAN HEALTH MICHIGAN CITY	Chesterton Health & Emergency Center (Free Standing Emergency Dept.)	770 Indian Boundary Road	Chesterton	IN	Terminated
RRC150015-03	Child	RRC	FRANCISCAN HEALTH MICHIGAN CITY	Woodland Cancer Care Center	8955 W 400 N	Michigan City	IN	Terminated
RRC150015-04	Child	RRC	FRANCISCAN HEALTH MICHIGAN CITY	Infusion OP Services / Chesterton Infusion Center	770 Indian Boundary Road	Chesterton	IN	Terminated
RRC150015-05	Child	RRC	FRANCISCAN HEALTH MICHIGAN CITY	FRANCISCAN HEALTH MICHIGAN CITY INF - Infusion Center at Munster	701 SUPERIOR AVENUE, SUITE 200	MUNSTER	IN	Terminated
RRC150015-06	Child	RRC	FRANCISCAN HEALTH MICHIGAN CITY	FRANCISCAN HEALTH MICHIGAN CITY INF - Infusion Center at Crown Point, Ground Floor	1201 S. MAIN STREET	CROWN POINT	IN	Terminated
RRC150015-07	Child	RRC	FRANCISCAN HEALTH MICHIGAN CITY	FRANCISCAN HEALTH MICHIGAN CITY INF - Infusion Center at Calumet	761 45TH AVE., SUITE 101/102	MUNSTER	IN	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Signed By	Update	Profile Change Request	Herron, Amy Regional CFO Franciscan Alliance 2198771033	Herron, Amy Regional CFO Franciscan Alliance 3175288470	10/21/2024 7:56 AM
Details	State	Update		To Be Terminated	Terminated	10/1/2024 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Hospital Type Change Request		10/1/2024 12:00:00 AM	7/22/2024 1:09 PM
Details	State	Update	Hospital Type Change Request	Active	To Be Terminated	7/22/2024 1:09 PM
Terminations	Termination Date	Update	Hospital Type Change Request		10/1/2024 12:00:00 AM	7/22/2024 1:09 PM
Terminations	Termination Effective Date	Update	Hospital Type Change Request		10/1/2024 12:00:00 AM	7/22/2024 1:09 PM
Terminations	Termination Reason	Update	Hospital Type Change Request		Change of covered entity type	7/22/2024 1:09 PM
Contacts	Authorizing Official	Update	Change Request	Herron, Amy Regional CFO Franciscan Alliance 2198771033	Kats, Justin Division CFO - Crown Point & Michigan City Franciscan Alliance 2197576403	7/1/2024 10:51 AM
Addresses	Shipping Address	Insert	Recertification		Franciscan Health Michigan City 3500 Franciscan Way Michigan City, IN 46360	9/11/2023 2:24 PM
Addresses	Shipping Address	Insert	Recertification		Franciscan Home Infusion Pharmacy Munster 757 45th Street Suite 102 Munster, IN 46321	9/11/2023 2:24 PM
Details	Last Recertification Date	Update	Recertification		9/11/2023 2:24:18 PM	9/11/2023 2:24 PM
Details	State	Update		Approved	Active	7/1/2023 12:01 AM
Contacts	Signed By	Insert	New Registration		Herron, Amy Regional CFO Franciscan Alliance 2198771033	6/7/2023 11:01 AM
Details	340B ID	Update	New Registration		RRC150015-05	6/7/2023 11:01 AM
Details	Entity Subname	Update	New Registration	FRANCISCAN HEALTH MICHIGAN CITY INF	FRANCISCAN HEALTH MICHIGAN CITY INF - Infusion Center at Munster	6/7/2023 11:01 AM
Dates	Participating Approval Date	Update	New Registration		6/7/2023 11:01:13 AM	6/7/2023 11:01 AM
Details	State	Update	New Registration	Pending	Approved	6/7/2023 11:01 AM
Dates	Signed By Date	Update	New Registration		5/7/2023 9:05:49 AM	6/7/2023 11:01 AM
Dates	Start Date	Update	New Registration		7/1/2023 12:00:00 AM	6/7/2023 11:01 AM
Addresses	Main Address	Insert	New Registration		701 SUPERIOR AVENUE, SUITE 200 MUNSTER, IN 46321-4037	5/3/2023 8:24 AM
Addresses	Billing Address	Insert	New Registration		Franciscan Health Michigan City 3500 Franciscan Way Michigan City, IN 46360	5/3/2023 8:24 AM
Addresses	Shipping Address	Insert	New Registration		Franciscan Health Munster Infusion Satellite Pharmacy 701 Superior Ave Munster, IN 46321	5/3/2023 8:24 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	5/3/2023 8:24 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		100269360A	5/3/2023 8:24 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		IN	5/3/2023 8:24 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1710051941	5/3/2023 8:24 AM
Medicaid Billing	NPI: State	Insert	New Registration		IN	5/3/2023 8:24 AM
Contacts	Primary Contact	Insert	New Registration		Shondell, Laura Administrative Director Medication Systems and Operations Franciscan Health 7654236900	5/3/2023 8:24 AM
Contacts	Authorizing Official	Insert	New Registration		Herron, Amy Regional CFO Franciscan Alliance 2198771033	5/3/2023 8:24 AM
Details	Assistance Received From Date	Insert	New Registration			5/3/2023 8:24 AM
Details	Assistance Received To Date	Insert	New Registration			5/3/2023 8:24 AM
Details	Last Recertification Date	Insert	New Registration			5/3/2023 8:24 AM
Details	Grant Number	Insert	New Registration			5/3/2023 8:24 AM
Details	340B ID	Insert	New Registration			5/3/2023 8:24 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			5/3/2023 8:24 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			5/3/2023 8:24 AM
Details	Medicare Provider Number	Insert	New Registration		150015	5/3/2023 8:24 AM
Details	Entity Name	Insert	New Registration		FRANCISCAN HEALTH MICHIGAN CITY	5/3/2023 8:24 AM
Details	NOFO Number	Insert	New Registration			5/3/2023 8:24 AM
Details	Program Code	Insert	New Registration		RRC	5/3/2023 8:24 AM
Details	Entity Subname	Insert	New Registration		FRANCISCAN HEALTH MICHIGAN CITY INF	5/3/2023 8:24 AM
Dates	Participating Approval Date	Insert	New Registration			5/3/2023 8:24 AM
Details	State	Insert	New Registration		Pending	5/3/2023 8:24 AM
Dates	Registration Date	Insert	New Registration		5/3/2023 8:24:14 AM	5/3/2023 8:24 AM
Dates	Signed By Date	Insert	New Registration			5/3/2023 8:24 AM
Dates	Start Date	Insert	New Registration			5/3/2023 8:24 AM
Terminations	Termination Comments	Insert	New Registration			5/3/2023 8:24 AM
Terminations	Termination Date	Insert	New Registration			5/3/2023 8:24 AM
Terminations	Termination Effective Date	Insert	New Registration			5/3/2023 8:24 AM
Terminations	Termination Reason	Insert	New Registration			5/3/2023 8:24 AM