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DSH150021BA PARKVIEW HOSPITAL (Terminated)
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Main Details
Name
PARKVIEW HOSPITAL
Subdivision Name
PRMC / MRI Outpatient Services
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH150021BA
Medicare Provider Number
150021
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/1/2015
Participating Start Date
1/1/2016
Participating Approval Date
10/28/2015
Last Recertification Date
8/15/2018
Termination Date
Termination Reason
10/1/2019
Outpatient facility moved within the 4 walls of the parent hospital
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
11109 Parkview Plaza Drive
Fort Wayne, IN 46845-1701
Billing Address
Parkview Memorial Hospital, INC
2200 Randallia Drive
Fort Wayne, IN 46805
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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