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DSH150021AZ PARKVIEW HOSPITAL (Terminated)
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Main Details
Name
PARKVIEW HOSPITAL
Subdivision Name
PRMC / Nuclear Medicine Outpatient Service Center
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH150021AZ
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
Other
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
2200 Randallia Dr
Fort Wayne, IN 46805
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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