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DSH150109D FRANCISCAN HEALTH LAFAYETTE (Terminated)
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Main Details
Name
FRANCISCAN HEALTH LAFAYETTE
Subdivision Name
Wound Care
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH150109D
Medicare Provider Number
150109
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/11/2016
Participating Start Date
1/1/2017
Participating Approval Date
10/25/2016
Last Recertification Date
11/7/2017
Termination Date
Termination Reason
7/1/2018
Outpatient facility moved within the 4 walls of the parent hospital
Contacts
Authorizing Official
Franciscan Health
Jason Geddes, Regional CFO
(765) 502-4599
Primary Contact
Franciscan Health
Laura Shondell, Administrative Director Medication Systems and Operations
(765) 423-6900
Addresses
Street Address
1501 Hartford St.
Lafayette, IN 47904
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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