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DSH150101 WHITLEY MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
WHITLEY MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH150101
Medicare Provider Number
150101
Additional Details
Current Program Status
Terminated
Registration Date
7/13/2015
Participating Start Date
10/1/2015
Participating Approval Date
7/21/2015
Last Recertification Date
8/15/2018
Termination Date
Termination Reason
7/1/2019
DSH percentage below statutory minimum
Contacts
Authorizing Official
Parkview Health
Jeanne Wickens, CFO
(260) 373-8407
Primary Contact
Parkview Health
Stephanie Dickmeyer, 340B Program Supervisor
(260) 266-4408
Addresses
Street Address
1260 E STATE ROAD 205
COLUMBIA CITY, IN 46725-9492
Billing Address
Parkview Memorial Hospital, Inc
2200 Randallia Dr
Fort Wayne, IN 46805
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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