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CAH151323-00 COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC. (Active)
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Main Details
Name
COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC.
Subdivision Name
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH151323-00
Medicare Provider Number
151323
Additional Details
Current Program Status
Active
Registration Date
2/22/2011
Participating Start Date
4/1/2011
Participating Approval Date
3/3/2011
Last Recertification Date
8/14/2024
Contacts
Authorizing Official
Parkview Health System
Stanton Risser, Assoc Chief Financial Officer
(260) 266-9313
Primary Contact
Parkview Health
Stephanie Dickmeyer, 340B Program Supervisor
(260) 266-4408
Addresses
Street Address
207 NORTH TOWNLINE ROAD
LAGRANGE, IN 46761
Billing Address
Parkview Memorial Hospital INC
2200 Randallia Dr
Fort Wayne, IN 46805-4699
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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2/16/12 update AO was R. Myers 04/29/11 REMOVED MEDICAID#(WAS200524440A)
02/16/2012
04/29/11 REMOVED MEDICAID#(WAS200524440A)
04/29/2011
April 2025
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