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DSH150058 MEMORIAL HOSPITAL OF SOUTH BEND, INC (Active)
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Main Details
Name
MEMORIAL HOSPITAL OF SOUTH BEND, INC
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH150058
Medicare Provider Number
150058
Additional Details
Current Program Status
Active
Registration Date
11/30/2006
Participating Start Date
1/1/2007
Participating Approval Date
11/30/2006
Last Recertification Date
8/29/2024
Contacts
Authorizing Official
Beacon Health System, Inc.
JEFFREY P. COSTELLO, CFO
(574) 647-3549
Primary Contact
Memorial Hospital of South Bend
Carmelo Pratico, Director of Pharmacy Services
(574) 647-4738
Addresses
Street Address
615 N MICHIGAN STREET
SOUTH BEND, IN 46601
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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